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General NPI Number Information
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NPI Number | 1568830313
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Entity Type | Individual
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Provider Name | TIARE SHELLER L.AC.
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Gender | Female
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Dates
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Enumeration Date | 09/10/2015
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | 1046 NE ORENCO STATION PKWY
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City | HILLSBORO
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State | OR
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Zip | 97124-7015
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Country | US
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Telephone | 503-505-0335
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Fax |
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Provider Business Mailing Address
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Address Line | 7033 SE CLINTON ST
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City | PORTLAND
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State | OR
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Zip | 97206-1102
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Country | US
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Telephone | 503-810-6928
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC174582
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License Number State | OR
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