Provider Demographics
NPI:1316713407
Name:AUCH, ABBY (LMT, MSW)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:AUCH
Suffix:
Gender:F
Credentials:LMT, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3569 NE SIMPSON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-7368
Mailing Address - Country:US
Mailing Address - Phone:971-322-3417
Mailing Address - Fax:
Practice Address - Street 1:6529 NE SANDY BLVD STE 203
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-4544
Practice Address - Country:US
Practice Address - Phone:971-322-3417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26640225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist