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General NPI Number Information
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NPI Number | 1295088649
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Entity Type | Individual
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Provider Name | KELLIE SUE VOLMER LMP, COTA
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Gender | Female
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Dates
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Enumeration Date | 10/23/2012
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Last Update Date | 08/27/2022
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Provider Practice Location Address
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Address Line | 3710 SW US VETERANS HOSPITAL RD
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City | PORTLAND
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State | OR
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Zip | 97239-2964
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Country | US
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Telephone | 503-220-8262
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Fax |
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Provider Business Mailing Address
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Address Line | 5401 LEARY AVE NW
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City | SEATTLE
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State | WA
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Zip | 98107-4070
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Country | US
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Telephone | 206-623-0373
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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 | MA60317012
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 452921
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License Number State | OR
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