Provider Demographics
NPI:1841957768
Name:CASTILLO, BRANDEE NICOLE (LMT)
Entity type:Individual
Prefix:
First Name:BRANDEE
Middle Name:NICOLE
Last Name:CASTILLO
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 1:5918 SE 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-4737
Mailing Address - Country:US
Mailing Address - Phone:503-334-8517
Mailing Address - Fax:
Practice Address - Street 1:2410 SE 10TH AVE # 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4624
Practice Address - Country:US
Practice Address - Phone:971-279-4454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-27
Last Update Date:2021-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26447225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist