Provider Demographics
NPI:1093959868
Name:CELESTE, MARGUERITE ANNE (LAC, LMT)
Entity type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:ANNE
Last Name:CELESTE
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:MARGUERITE
Other - Middle Name:ANNE
Other - Last Name:DOHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC, LMT
Mailing Address - Street 1:107 SE WASHINGTON ST STE 134
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2151
Mailing Address - Country:US
Mailing Address - Phone:503-239-2639
Mailing Address - Fax:
Practice Address - Street 1:107 SE WASHINGTON ST STE 134
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2151
Practice Address - Country:US
Practice Address - Phone:503-239-2639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU-1115171100000X
OR11590225700000X
HIMAT-12433225700000X
OR177230171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist