Provider Demographics
NPI:1154691053
Name:RICH, TIA LOUISE (CPM, LMT, LC, CIEM)
Entity type:Individual
Prefix:MS
First Name:TIA
Middle Name:LOUISE
Last Name:RICH
Suffix:
Gender:
Credentials:CPM, LMT, LC, CIEM
Other - Prefix:MS
Other - First Name:TINA
Other - Middle Name:LOUISE
Other - Last Name:RICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPM, LMT, LC, CIEM
Mailing Address - Street 1:11297 SW TONQUIN PL
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9546
Mailing Address - Country:US
Mailing Address - Phone:971-533-6496
Mailing Address - Fax:
Practice Address - Street 1:11297 SW TONQUIN PL
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9546
Practice Address - Country:US
Practice Address - Phone:971-533-6496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X, 176B00000X
OR26511225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No176B00000XOther Service ProvidersMidwife