Provider Demographics
NPI:1881970135
Name:TAYLOR, LAURA MARIE (LMT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:TAYLOR
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 1:8150 SW BARNES RD APT D304
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6375
Mailing Address - Country:US
Mailing Address - Phone:503-807-3131
Mailing Address - Fax:
Practice Address - Street 1:1427 NW FLANDERS ST STE A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2646
Practice Address - Country:US
Practice Address - Phone:503-972-0235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17681174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist