Provider Demographics
NPI:1659728665
Name:O'CONNOR, LORETTA (LMT)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:DR
Other - First Name:LORETTA
Other - Middle Name:MARIE
Other - Last Name:O'CONNOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2081 NW EVERETT ST APT 405
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1026
Mailing Address - Country:US
Mailing Address - Phone:971-322-7364
Mailing Address - Fax:
Practice Address - Street 1:443 NE KNOTT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3108
Practice Address - Country:US
Practice Address - Phone:503-282-5350
Practice Address - Fax:503-282-1990
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20771225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist