Provider Demographics
NPI:1619394079
Name:MICHELE WREN
Entity Type:Organization
Organization Name:MICHELE WREN
Other - Org Name:SERENE HEART THERAPEUTIC MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WREN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-730-2869
Mailing Address - Street 1:930 CUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-1730
Mailing Address - Country:US
Mailing Address - Phone:503-730-2869
Mailing Address - Fax:
Practice Address - Street 1:7303 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-2009
Practice Address - Country:US
Practice Address - Phone:503-297-3825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7937225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty