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General NPI Number Information
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NPI Number | 1194074484
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Entity Type | Individual
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Provider Name | ROXANNE FAYE O'HARA LMT
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Gender | Female
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Dates
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Enumeration Date | 09/03/2012
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 1611 SE BYBEE BLVD
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City | PORTLAND
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State | OR
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Zip | 97202-5752
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Country | US
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Telephone | 541-653-1341
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Fax | 866-473-0398
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Provider Business Mailing Address
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Address Line | 1611 SE BYBEE BLVD
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City | PORTLAND
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State | OR
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Zip | 97202-5752
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Country | US
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Telephone | 541-653-1341
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Fax | 866-473-0398
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 18908
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License Number State | OR
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