Provider Demographics
NPI:1164794277
Name:STRICKLAND, EVA M (LMT 15361)
Entity Type:Individual
Prefix:MISS
First Name:EVA
Middle Name:M
Last Name:STRICKLAND
Suffix:
Gender:F
Credentials:LMT 15361
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 SE CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1370
Mailing Address - Country:US
Mailing Address - Phone:503-327-5405
Mailing Address - Fax:
Practice Address - Street 1:833 SE MAIN ST
Practice Address - Street 2:SUITE 406
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3454
Practice Address - Country:US
Practice Address - Phone:503-327-5405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-04
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15361225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist