Provider Demographics
NPI:1093207599
Name:PEACE, ERIN TERESA
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:TERESA
Last Name:PEACE
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 1:7150 SW HAMPTON ST STE 113
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8365
Mailing Address - Country:US
Mailing Address - Phone:971-303-1908
Mailing Address - Fax:
Practice Address - Street 1:7150 SW HAMPTON ST STE 113
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8365
Practice Address - Country:US
Practice Address - Phone:971-303-1908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20168225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist