Provider Demographics
NPI:1902220643
Name:FOSTER, DIANE MAUREE (LMT)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MAUREE
Last Name:FOSTER
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 1:7046 NE EMERSON
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-3430
Mailing Address - Country:US
Mailing Address - Phone:503-261-9783
Mailing Address - Fax:503-255-2326
Practice Address - Street 1:7046 NE EMERSON
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-3430
Practice Address - Country:US
Practice Address - Phone:503-261-9783
Practice Address - Fax:503-255-2326
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2201225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist