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General NPI Number Information
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NPI Number | 1679908040
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Entity Type | Individual
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Provider Name | TERESA LYNN LAUGHLIN LMT
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Gender | Female
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Dates
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Enumeration Date | 09/04/2013
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Last Update Date | 09/04/2013
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Provider Practice Location Address
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Address Line | 506 SW 6TH AVE SUITE 801
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City | PORTLAND
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State | OR
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Zip | 97204-1533
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Country | US
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Telephone | 503-241-6505
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Fax |
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Provider Business Mailing Address
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Address Line | 3145 NE FLANDERS ST
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City | PORTLAND
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State | OR
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Zip | 97232-3371
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Country | US
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Telephone | 503-523-8125
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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 | 18398
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License Number State | OR
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