Provider Demographics
NPI:1124674346
Name:VELIMIROVIC, MARGARET GAMBLE LYNN (LMT)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:GAMBLE LYNN
Last Name:VELIMIROVIC
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5552
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97228-5552
Mailing Address - Country:US
Mailing Address - Phone:971-336-7149
Mailing Address - Fax:
Practice Address - Street 1:812 SW WASHINGTON ST STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3217
Practice Address - Country:US
Practice Address - Phone:971-336-7149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22070225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist