Provider Demographics
NPI:1639519374
Name:ALM, MEAGEN M (LMT)
Entity type:Individual
Prefix:
First Name:MEAGEN
Middle Name:M
Last Name:ALM
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 1:819 SE MORRISON ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-6307
Mailing Address - Country:US
Mailing Address - Phone:503-956-9396
Mailing Address - Fax:
Practice Address - Street 1:819 SE MORRISON ST
Practice Address - Street 2:SUITE 115
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-6307
Practice Address - Country:US
Practice Address - Phone:503-956-9396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROBMT 19902225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist