Provider Demographics
NPI:1417353053
Name:MCGUIRE-WYRICK, TAMARA X (LMT)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:MCGUIRE-WYRICK
Suffix:X
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 1:14800 NW CORNELL RD 17C
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229
Mailing Address - Country:US
Mailing Address - Phone:707-478-7581
Mailing Address - Fax:
Practice Address - Street 1:12923 NW CORNELL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229
Practice Address - Country:US
Practice Address - Phone:503-646-3393
Practice Address - Fax:503-672-7042
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18036225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist