Provider Demographics
NPI:1578790911
Name:MCDANIELS, TASHA MARIE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:TASHA
Middle Name:MARIE
Last Name:MCDANIELS
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 1:10120 SE WAVERLY CT
Mailing Address - Street 2:# 63
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7438
Mailing Address - Country:US
Mailing Address - Phone:503-753-4857
Mailing Address - Fax:
Practice Address - Street 1:10120 SE WAVERLY CT
Practice Address - Street 2:# 63
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7438
Practice Address - Country:US
Practice Address - Phone:503-753-4857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12820225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist