Provider Demographics
NPI:1164772422
Name:POWELL, EUGENIE LEE
Entity Type:Individual
Prefix:MRS
First Name:EUGENIE
Middle Name:LEE
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GENIE
Other - Middle Name:LEE
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:2706 SE 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-1854
Mailing Address - Country:US
Mailing Address - Phone:503-709-0253
Mailing Address - Fax:503-788-7649
Practice Address - Street 1:2706 SE 75TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-1854
Practice Address - Country:US
Practice Address - Phone:503-709-0253
Practice Address - Fax:503-788-7649
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18105225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist