Provider Demographics
NPI:1679816771
Name:DOYLE, CANDICE MAY (LMT#16669)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:MAY
Last Name:DOYLE
Suffix:
Gender:F
Credentials:LMT#16669
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 NE LINCOLN ST STE A
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-3048
Mailing Address - Country:US
Mailing Address - Phone:503-577-2499
Mailing Address - Fax:
Practice Address - Street 1:232 NE LINCOLN ST STE A
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-3048
Practice Address - Country:US
Practice Address - Phone:503-577-2499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR225700000X
OR16669225700000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR16669OtherOREGON BOARD OF MASSAGE THERAPY