Healthcare Provider Details

I. General information

NPI: 1265863047
Provider Name (Legal Business Name): KAREN ZOTTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2013
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 SE WASHINGTON ST APT 8
PORTLAND OR
97214-3065
US

IV. Provider business mailing address

2809 SE WASHINGTON ST APT 8
PORTLAND OR
97214-3065
US

V. Phone/Fax

Practice location:
  • Phone: 503-756-6398
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number17403
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: