Provider Demographics
NPI:1922084037
Name:KEEFER HUTCHISON, MARCEY LEE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MARCEY
Middle Name:LEE
Last Name:KEEFER HUTCHISON
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:STE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:121 MCNARY ESTATES DR N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-7459
Practice Address - Country:US
Practice Address - Phone:503-463-4221
Practice Address - Fax:503-463-4522
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR125968Medicaid
OR650016938OtherRR MEDICARE
R105043Medicare PIN
ORR176461Medicare PIN
OR125968Medicaid