Provider Demographics
NPI:1972145670
Name:MINDFUL MOVEMENT THERAPIES LLC
Entity type:Organization
Organization Name:MINDFUL MOVEMENT THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUSTEN
Authorized Official - Middle Name:RAIA
Authorized Official - Last Name:LINCOLN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:503-720-4634
Mailing Address - Street 1:4407 SW STEPHENSON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-7107
Mailing Address - Country:US
Mailing Address - Phone:503-720-4634
Mailing Address - Fax:844-250-7399
Practice Address - Street 1:4407 SW STEPHENSON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-7107
Practice Address - Country:US
Practice Address - Phone:503-720-4634
Practice Address - Fax:844-250-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty