Provider Demographics
NPI:1609021245
Name:TORGRIMSON, JOEY MICHELLE (CPM, LDM, LMT)
Entity type:Individual
Prefix:MISS
First Name:JOEY
Middle Name:MICHELLE
Last Name:TORGRIMSON
Suffix:
Gender:F
Credentials:CPM, LDM, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6635 NE HANCOCK CT
Mailing Address - Street 2:#200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-5089
Mailing Address - Country:US
Mailing Address - Phone:503-875-6257
Mailing Address - Fax:
Practice Address - Street 1:6635 NE HANCOCK CT
Practice Address - Street 2:#200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-5089
Practice Address - Country:US
Practice Address - Phone:503-875-6257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12921225700000X
OR10147174176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500643633Medicaid