Provider Demographics
NPI:1851149793
Name:FLETCHER, CHRISTINE ELAINE (LMT)
Entity type:Individual
Prefix:MISS
First Name:CHRISTINE
Middle Name:ELAINE
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KUDRA
Other - Middle Name:
Other - Last Name:FLETCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:715 SW KING AVE APT 22
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1454
Mailing Address - Country:US
Mailing Address - Phone:603-717-8242
Mailing Address - Fax:
Practice Address - Street 1:4230 NE FREMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1150
Practice Address - Country:US
Practice Address - Phone:503-208-5532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28016225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist