Provider Demographics
NPI:1467981191
Name:ORFORD, REBECCA JEAN (LMT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEAN
Last Name:ORFORD
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 1:4325 NE HALSEY ST APT 14
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1556
Mailing Address - Country:US
Mailing Address - Phone:406-239-5297
Mailing Address - Fax:
Practice Address - Street 1:4160 NE SANDY BLVD # 1100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-5336
Practice Address - Country:US
Practice Address - Phone:503-249-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22641225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist