Provider Demographics
NPI:1063029064
Name:JEFFREYS, ARIEL (LMT)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:JEFFREYS
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 1:1748 NW FAIRVIEW DR # A
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3842
Mailing Address - Country:US
Mailing Address - Phone:503-724-0378
Mailing Address - Fax:
Practice Address - Street 1:1748 NW FAIRVIEW DR # A
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3842
Practice Address - Country:US
Practice Address - Phone:503-724-0378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18297174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist