Provider Demographics
NPI:1477926210
Name:RICHTER-WILCOX, JUDITH LOUISE (LMT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:LOUISE
Last Name:RICHTER-WILCOX
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:PO BOX 1062
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-0075
Mailing Address - Country:US
Mailing Address - Phone:971-645-0777
Mailing Address - Fax:
Practice Address - Street 1:22000 WILLAMETTE DR STE 107
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-3210
Practice Address - Country:US
Practice Address - Phone:503-722-8888
Practice Address - Fax:503-722-9422
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21442225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist