Healthcare Provider Details

I. General information

NPI: 1609990571
Provider Name (Legal Business Name): CLARE KATNER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2007
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 E BURNSIDE ST STE 100
PORTLAND OR
97214-1655
US

IV. Provider business mailing address

5829 SE LAFAYETTE ST
PORTLAND OR
97206-2847
US

V. Phone/Fax

Practice location:
  • Phone: 503-314-9297
  • Fax: 971-319-2195
Mailing address:
  • Phone: 503-314-9297
  • Fax: 971-319-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6573
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: