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General NPI Number Information
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NPI Number | 1770081457
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Entity Type | Individual
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Provider Name | BROOKE NOELANI ROBISON SMITH LMT
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Gender | Female
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Dates
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Enumeration Date | 01/26/2018
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Last Update Date | 01/26/2018
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Provider Practice Location Address
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Address Line | 12795 SW 3RD ST
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City | BEAVERTON
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State | OR
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Zip | 97005-2704
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Country | US
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Telephone | 503-641-4244
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Fax | 503-641-0551
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Provider Business Mailing Address
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Address Line | 22737 NE HALSEY ST
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City | FAIRVIEW
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State | OR
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Zip | 97024-2709
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Country | US
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Telephone | 503-891-3120
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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 | 17388
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License Number State | OR
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