Individual
MARTIN KENNETH GAITER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2411 MLK JR BLVD, EUGENE, OR 97401-5824
(541) 682-3550
(541) 682-9861
Mailing address
2073 OLYMPIC ST, SPRINGFIELD, OR 97477-3413
(541) 682-3550
(541) 682-3551
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
108291
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2761438
OREGON DRIVER LICENSE
OR
Enumeration date
02/23/2023
Last updated
02/23/2023
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