Provider Demographics
NPI:1568720829
Name:KIRLEY, ALLISON DENISE (LMT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:DENISE
Last Name:KIRLEY
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 1:8833 N SYRACUSE ST
Mailing Address - Street 2:APT 5
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-4857
Mailing Address - Country:US
Mailing Address - Phone:503-703-1181
Mailing Address - Fax:
Practice Address - Street 1:5441 SW MACADAM AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6106
Practice Address - Country:US
Practice Address - Phone:503-841-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR133N00000X
OR18656225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No133N00000XDietary & Nutritional Service ProvidersNutritionist