Provider Demographics
NPI:1932898137
Name:REYNOLDSON, OLIVIA BROOKS (LAC, DAOM)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:BROOKS
Last Name:REYNOLDSON
Suffix:
Gender:F
Credentials:LAC, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2262 N ALBINA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1792
Mailing Address - Country:US
Mailing Address - Phone:503-493-9389
Mailing Address - Fax:
Practice Address - Street 1:2262 N ALBINA AVE STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1792
Practice Address - Country:US
Practice Address - Phone:503-493-9389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR213718171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist