Healthcare Provider Details

I. General information

NPI: 1972031862
Provider Name (Legal Business Name): KIRSTEN RICHTER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date: 11/14/2020
Reactivation Date: 05/06/2025

III. Provider practice location address

915 NE 2ND ST
GRESHAM OR
97030-7512
US

IV. Provider business mailing address

400 NE CLEVELAND AVE APT 1
GRESHAM OR
97030-5721
US

V. Phone/Fax

Practice location:
  • Phone: 503-766-3724
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number23268
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: