Healthcare Provider Details

I. General information

NPI: 1548708050
Provider Name (Legal Business Name): LAURA E KAETER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15220 NW GREENBRIER PKWY STE 260
BEAVERTON OR
97006-8111
US

IV. Provider business mailing address

3011 NE EMERSON ST
PORTLAND OR
97211-6905
US

V. Phone/Fax

Practice location:
  • Phone: 503-439-9494
  • Fax:
Mailing address:
  • Phone: 619-564-0644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number22062
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: