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General NPI Number Information
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NPI Number | 1083520613
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Entity Type | Organization
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Legal Business Name | KOI THERAPEUTICS LLC
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Dates
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Enumeration Date | 08/22/2026
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Last Update Date | 08/22/2026
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Provider Practice Location Address
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Address Line | 5441 S MACADAM AVE STE R
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City | PORTLAND
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State | OR
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Zip | 97239-3822
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Country | US
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Telephone | 424-398-6228
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 51482
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City | EUGENE
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State | OR
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Zip | 97405-0908
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | ANDREW GREMINGER
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Credential |
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Telephone | 424-398-6228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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