Individual
KATE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3934 NE MLK BLVD STE 108, PORTLAND, OR 97212-1153
(503) 381-1380
Mailing address
115 NE MASON ST, PORTLAND, OR 97211-3416
(503) 381-1380
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
22806
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22806
LMT
OR
Enumeration date
09/28/2017
Last updated
09/28/2017
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