MEDICARE: CADEN GILLASPY RN, LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	202105582RN	OR
2	225700000X	Massage Therapist	20126	OR

General Provider Information

NPI Number	:	1700281789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CADEN GILLASPY RN, LMT

Provider Business Mailing Address
First Line	:	150 NE 202ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97230-8120
Country	:	US
Telephone Number	:	503-329-1116
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 SE BELMONT ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-4327
Country	:	US
Telephone Number	:	503-329-1116
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2014
Last Update Date	:	06/22/2021

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