Provider Demographics
NPI:1346748613
Name:SAPOZNIKOW, IARA (LMT, CPM, LDM, CA)
Entity type:Individual
Prefix:
First Name:IARA
Middle Name:
Last Name:SAPOZNIKOW
Suffix:
Gender:F
Credentials:LMT, CPM, LDM, CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4607 NE 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-2014
Mailing Address - Country:US
Mailing Address - Phone:845-642-8446
Mailing Address - Fax:
Practice Address - Street 1:1411 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1485
Practice Address - Country:US
Practice Address - Phone:971-236-2592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23904225700000X
OR176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No176B00000XOther Service ProvidersMidwife