Healthcare Provider Details

I. General information

NPI: 1538388442
Provider Name (Legal Business Name): KATHLEEN MARIE LABAVITCH LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22455 SW OAK ST
SHERWOOD OR
97140-9354
US

IV. Provider business mailing address

22455 SW OAK ST
SHERWOOD OR
97140-9354
US

V. Phone/Fax

Practice location:
  • Phone: 503-925-8195
  • Fax:
Mailing address:
  • Phone: 503-925-8195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11826
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: