Individual
COOPER LEO PARADISE FOULKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.M.T.
Contact information
Practice address
1221 SE MADISON ST, PORTLAND, OR 97214-3890
(503) 445-7767
Mailing address
2125 SE OAK ST, PORTLAND, OR 97214-1606
(503) 459-1143
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
18488
OR
Other
Enumeration date
05/14/2012
Last updated
05/14/2012
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