=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184994295
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASHLEY POWELL, LMT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2012
-----------------------------------------------------
Last Update Date | 01/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 506 SW 6TH AVE SUITE 801
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97204-1533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-241-6505
-----------------------------------------------------
Fax | 503-296-2205
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 506 SW 6TH AVE SUITE 801
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97204-1533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-241-6505
-----------------------------------------------------
Fax | 503-296-2205
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. ASHLEY ELIZABETH POWELL
-----------------------------------------------------
Credential | L.M.T.
-----------------------------------------------------
Telephone | 503-382-9699
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 18104
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------