Individual
MR. SHAMUS MICHEAL RETTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
30 NE MARTIN LUTHER KING BLVD, PORTLAND, OR 97232-2941
(503) 232-1099
Mailing address
30 NE MARTIN LUTHER KING BLVD, PORTLAND, OR 97232-2941
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
FL
174400000X
Specialist
Primary
—
—
Other
Enumeration date
05/19/2017
Last updated
02/12/2021
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