Healthcare Provider Details

I. General information

NPI: 1750614939
Provider Name (Legal Business Name): MOKUTI MEDICAL ARTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2009
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 SW COMUS ST
PORTLAND OR
97219-7417
US

IV. Provider business mailing address

3727 SW COMUS ST
PORTLAND OR
97219-7417
US

V. Phone/Fax

Practice location:
  • Phone: 503-892-5160
  • Fax: 503-892-5160
Mailing address:
  • Phone: 503-892-5160
  • Fax: 503-892-5160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13743
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13858
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC154595
License Number StateOR

VIII. Authorized Official

Name: MARY E SCHLEIPFER
Title or Position: CO-OWNER
Credential: LMT
Phone: 503-892-5160