Provider Demographics
NPI:1619112802
Name:MAYFIELD, MAUREEN J (LMT)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:J
Last Name:MAYFIELD
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 1:6511 APOLLO RD
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-2803
Mailing Address - Country:US
Mailing Address - Phone:503-657-3435
Mailing Address - Fax:
Practice Address - Street 1:2150 8TH CT
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4365
Practice Address - Country:US
Practice Address - Phone:503-650-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6018225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist