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General NPI Number Information
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NPI Number | 1922978808
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Entity Type | Individual
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Provider Name | CHRISTINE NICHOLAS-JENANI
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Gender | Female
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Dates
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Enumeration Date | 11/06/2025
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 1733 E POWELL BLVD STE 102
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City | GRESHAM
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State | OR
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Zip | 97030-8013
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Country | US
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Telephone | 503-740-6343
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Fax |
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Provider Business Mailing Address
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Address Line | 7715 SW BONITA RD APT 35
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City | PORTLAND
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State | OR
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Zip | 97224-8136
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Country | US
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Telephone | 415-595-4997
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 1062391
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 29341
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License Number State | OR
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