Provider Demographics
NPI:1982830634
Name:BARKER, MICHELLE LEE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:LEE
Last Name:BARKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:TATE
Other - Middle Name:LEE
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:6345 N ALBINA AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-1863
Mailing Address - Country:US
Mailing Address - Phone:503-260-7785
Mailing Address - Fax:
Practice Address - Street 1:6345 N ALBINA AVE APT 4
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-1863
Practice Address - Country:US
Practice Address - Phone:503-260-7785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8283225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist