Provider Demographics
NPI:1811457377
Name:REED, TARAH MARIE (LMT, CCT)
Entity type:Individual
Prefix:MRS
First Name:TARAH
Middle Name:MARIE
Last Name:REED
Suffix:
Gender:F
Credentials:LMT, CCT
Other - Prefix:MRS
Other - First Name:TARAH
Other - Middle Name:MARIE
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT, CCT
Mailing Address - Street 1:2808 NE MLK JR BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3061
Mailing Address - Country:US
Mailing Address - Phone:971-255-1824
Mailing Address - Fax:
Practice Address - Street 1:2808 NE MLK JR BLVD STE C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3061
Practice Address - Country:US
Practice Address - Phone:971-255-1824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13361225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist