Provider Demographics
NPI:1861746760
Name:WINCHESTER, CAELIE JAYE
Entity type:Individual
Prefix:
First Name:CAELIE
Middle Name:JAYE
Last Name:WINCHESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8835 N HARTMAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-1008
Mailing Address - Country:US
Mailing Address - Phone:405-630-9799
Mailing Address - Fax:
Practice Address - Street 1:16784 SW VINCENT ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-1912
Practice Address - Country:US
Practice Address - Phone:971-506-4566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18337172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist