Provider Demographics
NPI:1366656324
Name:COFFEY, ASHLEY E (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:E
Last Name:COFFEY
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 1:1201 SW 12TH AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2046
Mailing Address - Country:US
Mailing Address - Phone:503-224-2425
Mailing Address - Fax:
Practice Address - Street 1:1201 SW 12TH AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2046
Practice Address - Country:US
Practice Address - Phone:503-224-2425
Practice Address - Fax:503-224-7512
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12935225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist