Provider Demographics
NPI:1821273418
Name:MASSEY, STEPHANIE JO (LMT)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:JO
Last Name:MASSEY
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 1:107 SE WASHINGTON ST
Mailing Address - Street 2:#125
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2103
Mailing Address - Country:US
Mailing Address - Phone:503-239-2639
Mailing Address - Fax:503-239-2639
Practice Address - Street 1:107 SE WASHINGTON ST
Practice Address - Street 2:#125
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2103
Practice Address - Country:US
Practice Address - Phone:503-239-2639
Practice Address - Fax:503-239-2639
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13098225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist