=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376358028
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAYSIE ARMANDINA FOX
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2025
-----------------------------------------------------
Last Update Date | 02/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25603 SE STARK ST
-----------------------------------------------------
City | TROUTDALE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97060-3305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-492-6851
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3500 NE 17TH ST APT 275
-----------------------------------------------------
City | GRESHAM
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97030-4579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-530-4457
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 27142
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------