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General NPI Number Information
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NPI Number | 1841987591
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Entity Type | Individual
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Provider Name | EDLAH ROCHELLE DODD
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Gender | Female
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Dates
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Enumeration Date | 04/21/2023
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 2343 SE TUALATIN VALLEY HWY
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City | HILLSBORO
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State | OR
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Zip | 97123-7976
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Country | US
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Telephone | 503-336-3456
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 N MERIDIAN ST APT 18
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City | NEWBERG
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State | OR
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Zip | 97132-6101
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Country | US
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Telephone | 503-550-2534
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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 | 17978
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License Number State | OR
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