Provider Demographics
NPI:1134824550
Name:HINKLE, ASHLEY SHARAYAH (LMT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SHARAYAH
Last Name:HINKLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SOPHIE
Other - Middle Name:
Other - Last Name:LALEO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:1215 SW 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1711
Mailing Address - Country:US
Mailing Address - Phone:804-402-4643
Mailing Address - Fax:
Practice Address - Street 1:1215 SW 18TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1711
Practice Address - Country:US
Practice Address - Phone:804-402-4643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26334225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty