Basic Information
| Provider Information | |||||||||
| NPI: | 1386022127 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEAUCHENE | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | N | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1480 NE VILLAGE ST | ||||||||
| Address2: | |||||||||
| City: | FAIRVIEW | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970243827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034896250 | ||||||||
| FaxNumber: | 5034891650 | ||||||||
| Practice Location | |||||||||
| Address1: | 1630 BEAVERCREEK RD | ||||||||
| Address2: | |||||||||
| City: | OREGON CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970454156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036070047 | ||||||||
| FaxNumber: | 5036070051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2015 | ||||||||
| LastUpdateDate: | 05/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 61010 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.