Collaine Brooke Faddis LMT

NPI 1184810301 - Specialist - 174400000X

NPI Details
NPI 1184810301
Gender Female
Enumeration Date 09/20/2007
Last Updated 09/20/2007
Entity Type Individual
Active Over 9 years ago
Practice Location
4512 SE WOODSTOCK BLVD
PORTLAND OR, 97206-6274, US
Phone (503) 777-2776
Fax
Business Location
3031 SE 53RD AVE
PORTLAND OR, 97206-2119, US
Phone (503) 810-4941
Fax
Toxanomy
Taxonomy Code 174400000X
License State Oregon
License Number 14317
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According to our database, Collaine Brooke Faddis LMT NPI is 1184810301, taxonomy code is 174400000X and license number is 14317, license state is located at Oregon. Collaine Brooke Faddis LMT physically located at 4512 Se Woodstock Blvd, Portland OR, 97206-6274. NPI Number Collaine Brooke Faddis LMT has the Individual type.

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1184810301 NPI number is provided on an as is basis without warranty of any kind. 1184810301 is maintained by the National Plan & Provider Enumeration System. The contents of Collaine Brooke Faddis LMT are for informational purposes only.