Provider Demographics
NPI:1750972139
Name:TSCHUDY, MERELENE
Entity type:Individual
Prefix:
First Name:MERELENE
Middle Name:
Last Name:TSCHUDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39895 EVANS ST
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-9321
Mailing Address - Country:US
Mailing Address - Phone:503-919-1426
Mailing Address - Fax:
Practice Address - Street 1:38971 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-8080
Practice Address - Country:US
Practice Address - Phone:503-826-0141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25631225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist