Healthcare Provider Details

I. General information

NPI: 1962945303
Provider Name (Legal Business Name): KALI HULL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2016
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E MAIN ST
ROGUE RIVER OR
97537-9615
US

IV. Provider business mailing address

PO BOX 255
ROGUE RIVER OR
97537-0255
US

V. Phone/Fax

Practice location:
  • Phone: 541-450-9272
  • Fax:
Mailing address:
  • Phone: 541-450-9272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number21582
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: