Provider Demographics
NPI:1679998330
Name:MCDANIEL, IMUYA LEE DOOLEY (LMT)
Entity type:Individual
Prefix:MRS
First Name:IMUYA
Middle Name:LEE DOOLEY
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:IMUYA
Other - Middle Name:LEE
Other - Last Name:DOOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14010 SE 97TH AVE
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-8660
Mailing Address - Country:US
Mailing Address - Phone:971-219-0237
Mailing Address - Fax:
Practice Address - Street 1:14010 SE 97TH AVE
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8660
Practice Address - Country:US
Practice Address - Phone:971-219-0237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20463225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist