Provider Demographics
NPI:1780240713
Name:THOMPSON, CHRISTIE ELLEN (LMT)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:ELLEN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:CHRISTIE
Other - Middle Name:ELLEN
Other - Last Name:HUBBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1659 NE MARKET
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024
Mailing Address - Country:US
Mailing Address - Phone:503-465-9100
Mailing Address - Fax:
Practice Address - Street 1:1659 NE MARKET DRIVE
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OR
Practice Address - Zip Code:97024
Practice Address - Country:US
Practice Address - Phone:503-465-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24032225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist