Provider Demographics
NPI:1467639757
Name:FIELD, MICHELLE E (LMT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:E
Last Name:FIELD
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 1:8946 NW MILLS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97231-1237
Mailing Address - Country:US
Mailing Address - Phone:971-221-8120
Mailing Address - Fax:
Practice Address - Street 1:419 NW 23RD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3470
Practice Address - Country:US
Practice Address - Phone:971-221-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14740174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist