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NPI Code Detail

MEDICARE: MRS. CAROL SUE KIRCHER-SAMPSON OTR CHT

MEDICARE: MRS. CAROL SUE KIRCHER-SAMPSON OTR CHT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171W00000XContractorOT00000149WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
206769OTHERWAL&I
3K14454OTHERWAREGENCE

General Provider Information

NPI Number : 1184726168
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CAROL SUE KIRCHER-SAMPSON OTR CHT
Provider Business Mailing Address
First Line : 1953 PALISADES TERRACE DR
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97034-4627
Country : US
Telephone Number : 503-697-8654
Fax Number :
Provider Business Practice Location Address
First Line : 945 11TH AVE
Second Line : SUITE A
City : LONGVIEW
State : WA
Zip : 98632-2555
Country : US
Telephone Number : 360-577-1192
Fax Number : 360-577-0519
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. CAROL SUE KIRCHER-SAMPSON OTR CHT” Practice Location

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