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General NPI Number Information
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NPI Number | 1891162640
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Entity Type | Organization
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Legal Business Name | WILLOW TREE WELLNESS CLINIC
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Dates
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Enumeration Date | 08/27/2015
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Last Update Date | 08/27/2015
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Provider Practice Location Address
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Address Line | 1607 NE 16TH AVE
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City | PORTLAND
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State | OR
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Zip | 97232-1413
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Country | US
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Telephone | 503-281-0030
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Fax |
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Provider Business Mailing Address
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Address Line | 2714 NE DUNCKLEY ST
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City | PORTLAND
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State | OR
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Zip | 97212-1644
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER AND LICENSED ACUPUNCTURIST
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Name | KINE FISCHLER
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Credential | LAC
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Telephone | 503-281-0030
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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 | AC 01259
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License Number State | OR
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