Provider Demographics
NPI:1770069742
Name:SEASHORE, SARAH AVALON
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:AVALON
Last Name:SEASHORE
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 1:13365 SW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-4661
Mailing Address - Country:US
Mailing Address - Phone:505-503-4435
Mailing Address - Fax:
Practice Address - Street 1:6125 NE CORNELL RD STE 390
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5417
Practice Address - Country:US
Practice Address - Phone:503-530-8517
Practice Address - Fax:503-530-8517
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24090225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist