Provider Demographics
NPI:1962682377
Name:DRISCOLL, NICOL J (LMT)
Entity Type:Individual
Prefix:
First Name:NICOL
Middle Name:J
Last Name:DRISCOLL
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 1:3706 SE NEHALEM ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-8036
Mailing Address - Country:US
Mailing Address - Phone:503-282-6552
Mailing Address - Fax:
Practice Address - Street 1:7904 SE 13TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6667
Practice Address - Country:US
Practice Address - Phone:503-282-6552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10988OtherSTATE LICENSE