Provider Demographics
NPI:1871730572
Name:ORTON, ANGELA C (BS, LMT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:ORTON
Suffix:
Gender:F
Credentials:BS, LMT
Other - Prefix:
Other - First Name:ANGI
Other - Middle Name:
Other - Last Name:ORTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS, LMT
Mailing Address - Street 1:4230 NE 79TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-4204
Mailing Address - Country:US
Mailing Address - Phone:503-327-4959
Mailing Address - Fax:
Practice Address - Street 1:118 N KILLINGSWORTH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-2435
Practice Address - Country:US
Practice Address - Phone:503-288-4454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14212225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist