Provider Demographics
NPI:1043517535
Name:(WELCH) RITCHEY, CAROLYN (LMT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:(WELCH) RITCHEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 SE 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3423
Mailing Address - Country:US
Mailing Address - Phone:503-777-7080
Mailing Address - Fax:
Practice Address - Street 1:29292 SW TOWN CENTER LOOP E
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9491
Practice Address - Country:US
Practice Address - Phone:503-582-9200
Practice Address - Fax:503-582-1487
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6689225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist