Provider Demographics
NPI:1750191573
Name:STARFIRE, MICHELLE RIVER (LMT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RIVER
Last Name:STARFIRE
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 1:1560 17TH ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-7904
Mailing Address - Country:US
Mailing Address - Phone:971-719-7022
Mailing Address - Fax:
Practice Address - Street 1:717 E 1ST ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2917
Practice Address - Country:US
Practice Address - Phone:503-538-9867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28720225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty