MEDICARE: KAVIKA ULREY LMT

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
1	225700000X	Massage Therapist	25556	OR

General Provider Information

NPI Number	:	1205474038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAVIKA ULREY LMT

Provider Business Mailing Address
First Line	:	7490 BATTLE CREEK RD SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97317-9337
Country	:	US
Telephone Number	:	503-509-2869
Fax Number	:

Provider Business Practice Location Address
First Line	:	3990 CHERRY AVE NE STE 103
Second Line	:
City	:	KEIZER
State	:	OR
Zip	:	97303-4888
Country	:	US
Telephone Number	:	503-364-9242
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2019
Last Update Date	:	12/11/2019

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Directions to “ KAVIKA ULREY LMT” Practice Location

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