=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497110761
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMI K ODA, LMT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2015
-----------------------------------------------------
Last Update Date | 12/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5215 NE ELAM YOUNG PKWY SUITE A
-----------------------------------------------------
City | HILLSBORO
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97124-6498
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-908-0689
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21512 NW MIRIAM WAY
-----------------------------------------------------
City | HILLSBORO
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97006-1009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-908-0689
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MASSAGE THERAPIST
-----------------------------------------------------
Name | MRS. EMI KATHRYN ODA
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 540-908-0689
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 20422
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------