Provider Demographics
NPI:1942402102
Name:PARMER, CANDACE DENISE (LMT)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:DENISE
Last Name:PARMER
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 1:1314 NW IRVING ST
Mailing Address - Street 2:#705
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2721
Mailing Address - Country:US
Mailing Address - Phone:503-775-1812
Mailing Address - Fax:
Practice Address - Street 1:1314 NW IRVING ST
Practice Address - Street 2:#705
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2721
Practice Address - Country:US
Practice Address - Phone:503-775-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13760225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist