Provider Demographics
NPI:1770081457
Name:SMITH, BROOKE NOELANI ROBISON (LMT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:NOELANI ROBISON
Last Name:SMITH
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 1:22737 NE HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-2709
Mailing Address - Country:US
Mailing Address - Phone:503-891-3120
Mailing Address - Fax:
Practice Address - Street 1:12795 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2704
Practice Address - Country:US
Practice Address - Phone:503-641-4244
Practice Address - Fax:503-641-0551
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17388225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist