Provider Demographics
NPI:1679082861
Name:BLAIR, ERICA S (LMT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:S
Last Name:BLAIR
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 1:1550 NW EASTMAN PKWY
Mailing Address - Street 2:SUITE 265
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030
Mailing Address - Country:US
Mailing Address - Phone:503-669-1966
Mailing Address - Fax:503-667-6599
Practice Address - Street 1:1550 NW EASTMAN PKWY STE 265
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3860
Practice Address - Country:US
Practice Address - Phone:503-669-1966
Practice Address - Fax:503-667-6599
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18187225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist