Provider Demographics
NPI:1073025524
Name:PLISCHKE BLAIR, DOREEN
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:
Last Name:PLISCHKE BLAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8315 N DENVER AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-6707
Mailing Address - Country:US
Mailing Address - Phone:503-285-6227
Mailing Address - Fax:
Practice Address - Street 1:8315 N DENVER AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-6707
Practice Address - Country:US
Practice Address - Phone:503-285-6227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22609225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist