Provider Demographics
NPI:1912214578
Name:BURCH, JAYME (LMT #10867)
Entity Type:Individual
Prefix:MS
First Name:JAYME
Middle Name:
Last Name:BURCH
Suffix:
Gender:F
Credentials:LMT #10867
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 SE BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4330
Mailing Address - Country:US
Mailing Address - Phone:971-645-3833
Mailing Address - Fax:
Practice Address - Street 1:3810 SE BELMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4330
Practice Address - Country:US
Practice Address - Phone:971-645-3833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10867225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist