Provider Demographics
NPI:1063654804
Name:OBENCHAIN, MEREDITH ANNE (LMT, DIPL ABT)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ANNE
Last Name:OBENCHAIN
Suffix:
Gender:F
Credentials:LMT, DIPL ABT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10956 SE AZAR DR
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-7804
Mailing Address - Country:US
Mailing Address - Phone:208-724-0343
Mailing Address - Fax:
Practice Address - Street 1:8283 SW BARBUR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2871
Practice Address - Country:US
Practice Address - Phone:503-244-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15668225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist