Provider Demographics
NPI:1679331540
Name:MAHER, CHRISTIAN JAMES EUGENE
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:JAMES EUGENE
Last Name:MAHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11631 SW TEAL BLVD APT D
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8078
Mailing Address - Country:US
Mailing Address - Phone:720-595-1366
Mailing Address - Fax:
Practice Address - Street 1:2167 NW 185TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7074
Practice Address - Country:US
Practice Address - Phone:503-389-6690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28149225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist