Individual
ELLEN KATHERINE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
10225 SE RAYMOND ST, PORTLAND, OR 97266-3635
(971) 266-1322
Mailing address
10225 SE RAYMOND ST, PORTLAND, OR 97266-3635
(971) 266-1322
Taxonomy
Speciality
Code
Description
License number
State
173C00000X
Reflexologist
20920
OR
173C00000X
Reflexologist
MT121462
TX
225700000X
Massage Therapist
Primary
20920
OR
225700000X
Massage Therapist
MT121462
TX
226300000X
Kinesiotherapist
202920
OR
226300000X
Kinesiotherapist
MT121462
TX
Other
Enumeration date
03/20/2015
Last updated
03/20/2015
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