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General NPI Number Information
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NPI Number | 1053657536
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Entity Type | Organization
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Legal Business Name | INTOUCH MASSAGE LLC
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Dates
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Enumeration Date | 01/02/2013
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Last Update Date | 01/02/2013
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Provider Practice Location Address
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Address Line | 15962 BOONES FERRY RD STE 209
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-4360
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Country | US
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Telephone | 503-639-6751
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Fax |
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Provider Business Mailing Address
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Address Line | 8120 SW PETERS RD
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City | PORTLAND
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State | OR
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Zip | 97224-7622
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Country | US
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Telephone | 503-639-6963
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | LAURIE E VOLM
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Credential | LMT
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Telephone | 503-639-6751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 18940
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License Number State | OR
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