Healthcare Provider Details

I. General information

NPI: 1609694496
Provider Name (Legal Business Name): JOSIE A KILPATRICK LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 VALLEY RIVER WAY STE 106
EUGENE OR
97401-2187
US

IV. Provider business mailing address

1011 VALLEY RIVER WAY STE 106
EUGENE OR
97401-2187
US

V. Phone/Fax

Practice location:
  • Phone: 541-514-4819
  • Fax: 541-897-8112
Mailing address:
  • Phone: 541-514-4819
  • Fax: 541-897-8112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number28213
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: