Provider Demographics
NPI:1194122101
Name:CHERI M. ROULET, LMT
Entity type:Organization
Organization Name:CHERI M. ROULET, LMT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROULET
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-701-7072
Mailing Address - Street 1:PO BOX 68881
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97268
Mailing Address - Country:US
Mailing Address - Phone:503-701-7072
Mailing Address - Fax:503-786-8731
Practice Address - Street 1:29955 SW BOONES FERRY RD STE J
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9228
Practice Address - Country:US
Practice Address - Phone:503-701-7072
Practice Address - Fax:503-786-8731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7584225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty