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General NPI Number Information
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NPI Number | 1366683534
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Entity Type | Individual
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Provider Name | MARICLARE DALY L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 03/28/2014
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Provider Practice Location Address
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Address Line | 2106 NE 47TH AVE
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City | PORTLAND
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State | OR
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Zip | 97213-2064
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Country | US
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Telephone | 503-282-7581
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Fax |
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Provider Business Mailing Address
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Address Line | 4993 SE 30TH AVE APT 98
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City | PORTLAND
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State | OR
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Zip | 97202-4580
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Country | US
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Telephone | 971-279-5108
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Fax |
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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 | 15608
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License Number State | OR
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