Provider Demographics
NPI:1386035384
Name:SCAGLIONE, SERENA MARIE (LMT)
Entity Type:Individual
Prefix:MS
First Name:SERENA
Middle Name:MARIE
Last Name:SCAGLIONE
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 1:8925 N EDISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-2906
Mailing Address - Country:US
Mailing Address - Phone:503-805-3394
Mailing Address - Fax:
Practice Address - Street 1:2505 SE 11TH AVE
Practice Address - Street 2:SUITE 272
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1061
Practice Address - Country:US
Practice Address - Phone:503-805-3394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20823225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist