Provider Demographics
NPI:1255606513
Name:RICE, PAMELA RUTH (LMT)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:RUTH
Last Name:RICE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12200 SE MCLOUGHLIN BLVD
Mailing Address - Street 2:APT.#11-202
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7281
Mailing Address - Country:US
Mailing Address - Phone:503-758-3917
Mailing Address - Fax:
Practice Address - Street 1:5441 SW MACADAM AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6106
Practice Address - Country:US
Practice Address - Phone:503-841-6222
Practice Address - Fax:503-841-6199
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10215174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist