Provider Demographics
NPI:1073833562
Name:DUSEK, MICHELLE D (LMT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:DUSEK
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 1:2100 SE LAKE RD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7759
Mailing Address - Country:US
Mailing Address - Phone:503-490-2693
Mailing Address - Fax:503-405-7259
Practice Address - Street 1:2100 SE LAKE RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7759
Practice Address - Country:US
Practice Address - Phone:503-490-2693
Practice Address - Fax:503-405-7259
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15528225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist