Provider Demographics
NPI:1821478173
Name:FAIR-LAYMAN, ERIC (LMT; BA; MAT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:FAIR-LAYMAN
Suffix:
Gender:M
Credentials:LMT; BA; MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 SE ANKENY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1349
Mailing Address - Country:US
Mailing Address - Phone:971-236-7610
Mailing Address - Fax:
Practice Address - Street 1:905 SE ANKENY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1349
Practice Address - Country:US
Practice Address - Phone:971-236-7610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19568174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist