Healthcare Provider Details

I. General information

NPI: 1568631232
Provider Name (Legal Business Name): AFTON KENDELL L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 03/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NE ROBERTS AVE
GRESHAM OR
97030-7551
US

IV. Provider business mailing address

8005 NE 32ND ST
VANCOUVER WA
98662-7297
US

V. Phone/Fax

Practice location:
  • Phone: 503-758-8820
  • Fax:
Mailing address:
  • Phone: 503-758-8820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number7074
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: