Provider Demographics
NPI:1508007907
Name:GAZELEY, ANN L (LMT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:L
Last Name:GAZELEY
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 1:521 SW 11TH AVE
Mailing Address - Street 2:#306
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2634
Mailing Address - Country:US
Mailing Address - Phone:503-230-7136
Mailing Address - Fax:
Practice Address - Street 1:521 SW 11TH AVE
Practice Address - Street 2:#306
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2634
Practice Address - Country:US
Practice Address - Phone:503-230-7136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5931225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist