Provider Demographics
NPI:1205061884
Name:HALL, CASSIE DESIREE (LMT)
Entity type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:DESIREE
Last Name:HALL
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 1:53051 NW OLEPHA DR
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-2721
Mailing Address - Country:US
Mailing Address - Phone:503-863-0707
Mailing Address - Fax:503-397-7113
Practice Address - Street 1:163 N 11TH ST
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-1803
Practice Address - Country:US
Practice Address - Phone:503-863-0707
Practice Address - Fax:503-397-7113
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14640225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist