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General NPI Number Information
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NPI Number | 1366762056
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Entity Type | Organization
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Legal Business Name | DR. MARY CASELLI PC
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Dates
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Enumeration Date | 06/04/2010
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Last Update Date | 06/04/2010
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Provider Practice Location Address
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Address Line | 2119 NE HALSEY ST
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City | PORTLAND
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State | OR
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Zip | 97232-1522
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Country | US
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Telephone | 503-335-8983
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Fax | 503-517-8590
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Provider Business Mailing Address
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Address Line | 2025 NE 24TH AVE
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City | PORTLAND
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State | OR
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Zip | 97212-4722
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Country | US
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Telephone | 503-335-8983
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Fax | 503-517-8590
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. MARY F CASELLI
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Credential | N.D.
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Telephone | 503-335-8983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 0627
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License Number State | OR
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