Provider Demographics
NPI:1861076291
Name:ECKES, TABITHA R K (LMT)
Entity type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:R K
Last Name:ECKES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19039
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97280-0039
Mailing Address - Country:US
Mailing Address - Phone:253-348-5567
Mailing Address - Fax:
Practice Address - Street 1:15895 SW 72ND AVE STE 120
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-7984
Practice Address - Country:US
Practice Address - Phone:503-430-1952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26366225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist