Provider Demographics
NPI:1639307580
Name:VOETBERG, JULIE KAREN (LMT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:KAREN
Last Name:VOETBERG
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 1:1950 NW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-4936
Mailing Address - Country:US
Mailing Address - Phone:503-475-7651
Mailing Address - Fax:
Practice Address - Street 1:655 NW BURNSIDE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3745
Practice Address - Country:US
Practice Address - Phone:503-475-7651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5393225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist