Provider Demographics
NPI:1902142375
Name:WILDMAN, SHARALEE GAIL (RMT, LMT)
Entity Type:Individual
Prefix:
First Name:SHARALEE
Middle Name:GAIL
Last Name:WILDMAN
Suffix:
Gender:F
Credentials:RMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 S.E. WALNUT AVENUE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338
Mailing Address - Country:US
Mailing Address - Phone:503-623-2262
Mailing Address - Fax:
Practice Address - Street 1:297 SE WALNUT AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-2913
Practice Address - Country:US
Practice Address - Phone:503-623-2262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist