Provider Demographics
NPI:1457668782
Name:STRICKLAND GUILBAULT, HEATHER INEZ (LMT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:INEZ
Last Name:STRICKLAND GUILBAULT
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 1:837 E POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7617
Mailing Address - Country:US
Mailing Address - Phone:503-669-9495
Mailing Address - Fax:503-669-8257
Practice Address - Street 1:837 E POWELL BLVD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7617
Practice Address - Country:US
Practice Address - Phone:503-669-9495
Practice Address - Fax:503-669-8257
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16048225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist