Provider Demographics
NPI:1578867883
Name:FELLER, ERIN BAY (LMT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:BAY
Last Name:FELLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:BAY
Other - Last Name:WHITCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:14845 SW MURRAY SCHOLLS DR
Mailing Address - Street 2:SUITE 110 PMB 614
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-9237
Mailing Address - Country:US
Mailing Address - Phone:503-536-5546
Mailing Address - Fax:
Practice Address - Street 1:15860 SW MISTY CT
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-4922
Practice Address - Country:US
Practice Address - Phone:503-536-5546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15644225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist