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General NPI Number Information
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NPI Number | 1205474038
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Entity Type | Individual
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Provider Name | KAVIKA ULREY LMT
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Gender | Female
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Dates
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Enumeration Date | 12/11/2019
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Last Update Date | 12/11/2019
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Provider Practice Location Address
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Address Line | 3990 CHERRY AVE NE STE 103
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City | KEIZER
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State | OR
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Zip | 97303-4888
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Country | US
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Telephone | 503-364-9242
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Fax |
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Provider Business Mailing Address
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Address Line | 7490 BATTLE CREEK RD SE
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City | SALEM
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State | OR
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Zip | 97317-9337
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Country | US
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Telephone | 503-509-2869
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 25556
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License Number State | OR
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