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General NPI Number Information
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NPI Number | 1821262262
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Entity Type | Individual
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Provider Name | MELISSA DAWN STEWART LMT
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Gender | Female
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 8565 SW BEAVERTON HILLSDALE HWY SUITE 3
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City | PORTLAND
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State | OR
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Zip | 97225-2433
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Country | US
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Telephone | 503-805-0508
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Fax |
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Provider Business Mailing Address
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Address Line | 10865 SW 82ND AVE
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City | TIGARD
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State | OR
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Zip | 97223-8405
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Country | US
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Telephone | 503-805-0508
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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 | 12307
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License Number State | OR
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