Provider Demographics
NPI:1881039006
Name:SMITH, ERIN NICOLE (LMT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:NICOLE
Last Name:SMITH
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 1:2241 NW HOYT ST APT 108
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3789
Mailing Address - Country:US
Mailing Address - Phone:503-887-9013
Mailing Address - Fax:
Practice Address - Street 1:2241 NW HOYT ST APT 108
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3789
Practice Address - Country:US
Practice Address - Phone:503-887-9013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11693225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR11693OtherMASSAGE LICENSE NUMBER