=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235448242
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN A. BALL LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2010
-----------------------------------------------------
Last Update Date | 07/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5415 SW 185TH AVE
-----------------------------------------------------
City | BEAVERTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97078-3068
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-747-7084
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5415 SW 185TH AVE
-----------------------------------------------------
City | BEAVERTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97078-3068
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-747-7084
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 4514
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------