Provider Demographics
NPI:1881256659
Name:GAMBRELL-KREBS, HAILEE ELIZABETH (LMT)
Entity type:Individual
Prefix:
First Name:HAILEE
Middle Name:ELIZABETH
Last Name:GAMBRELL-KREBS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:HAILEE
Other - Middle Name:ELIZABETH
Other - Last Name:SWARTSFAGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10455 SE COOK CT APT 168
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97222-9015
Mailing Address - Country:US
Mailing Address - Phone:541-636-6245
Mailing Address - Fax:
Practice Address - Street 1:12741 NE HALSEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-2343
Practice Address - Country:US
Practice Address - Phone:503-255-0306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24306225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR24306OtherLMT NUMBER