Provider Demographics
NPI:1285419051
Name:MCBRIDE, STEPHANIE KAY
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KAY
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:
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 295
Mailing Address - Street 2:
Mailing Address - City:MANZANITA
Mailing Address - State:OR
Mailing Address - Zip Code:97130-0295
Mailing Address - Country:US
Mailing Address - Phone:503-341-3130
Mailing Address - Fax:
Practice Address - Street 1:15455 NW GREENBRIER PKWY STE 250
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-8116
Practice Address - Country:US
Practice Address - Phone:971-248-0068
Practice Address - Fax:971-256-9922
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20577225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist