Provider Demographics
NPI:1720481625
Name:LITTLE-REECE, MAGGIE SOJOURNER (LMT)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:SOJOURNER
Last Name:LITTLE-REECE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10500 SE 26TH AVE APT B30
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-9608
Mailing Address - Country:US
Mailing Address - Phone:503-577-1161
Mailing Address - Fax:
Practice Address - Street 1:10500 SE 26TH AVE APT B30
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-9608
Practice Address - Country:US
Practice Address - Phone:503-577-1161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20549225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist