Provider Demographics
NPI:1861898231
Name:ROULET, CHERI MARIE (LMT)
Entity type:Individual
Prefix:
First Name:CHERI
Middle Name:MARIE
Last Name:ROULET
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 68881
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97268
Mailing Address - Country:US
Mailing Address - Phone:503-701-7072
Mailing Address - Fax:503-786-8731
Practice Address - Street 1:29955 SW BOONES FERRY RD STE J
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9228
Practice Address - Country:US
Practice Address - Phone:503-701-7072
Practice Address - Fax:503-786-8731
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7584225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist