NPI 1083993091

Autumn L Roulan, LMT

Practitioner Contractor Portland, OR

Practice location

Address: 5835 NE Davis St., Portland, OR 97213-0000
Phone: (503) 231-8818
Mailing address: 5835 NE Davis St., Portland, OR 97213

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X Licence OBMT6906 (OR)

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Registry record

NPI: 1083993091
Entity type: Individual
Sex (as registered): Female
NPI issued: 8 Aug 2011
Record last updated: 8 Aug 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.