Provider Demographics
NPI:1699108175
Name:POPE-REID, MOIRA TELETHA
Entity type:Individual
Prefix:MRS
First Name:MOIRA
Middle Name:TELETHA
Last Name:POPE-REID
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 1:2004 NE CRAMER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-5467
Mailing Address - Country:US
Mailing Address - Phone:503-380-9623
Mailing Address - Fax:
Practice Address - Street 1:2004 NE CRAMER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-5467
Practice Address - Country:US
Practice Address - Phone:503-380-9623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17820225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist