Individual
MRS. KAITLIN ELIZABETH DEVINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1505 WATER ST NE, SALEM, OR 97301-6467
(503) 507-6443
Mailing address
310 N LARCH AVE, STAYTON, OR 97383-1556
(503) 507-6443
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
20599
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20599
MASSAGE THERAPY
OR
Enumeration date
03/01/2019
Last updated
03/01/2019
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