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General NPI Number Information
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NPI Number | 1336786953
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Entity Type | Organization
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Legal Business Name | OKAERI MASSAGE THERAPY LLC
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Dates
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Enumeration Date | 12/02/2019
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Last Update Date | 12/02/2019
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Provider Practice Location Address
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Address Line | 22400 SE STARK ST
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City | GRESHAM
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State | OR
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Zip | 97030-2656
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Country | US
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Telephone | 541-510-8476
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Fax |
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Provider Business Mailing Address
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Address Line | 2827 SE COLT DR APT 252
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City | PORTLAND
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State | OR
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Zip | 97202-4493
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Country | US
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Telephone | 503-701-9409
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMANTHA WALKER
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Credential | LMT
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Telephone | 503-701-9409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number |
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License Number State |
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