Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | ||
N | 225700000X | Massage Therapist | 18614 | OR |
NPI | 1184992810 |
---|---|
Provider Name | Ms. Anne C Tegtmeier |
First Address | Portland, OR 97236-5017 |
Second Address | Portland, OR 97236-5017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2011 |
Last Update Date | 15/12/2014 |