MEDICARE: MRS. KAITLIN ELIZABETH DEVINE 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	261QM2500X	Medical Specialty Clinic/Center	20599	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20599	OTHER	OR	MASSAGE THERAPY

General Provider Information

NPI Number	:	1780141390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAITLIN ELIZABETH DEVINE LMT

Provider Business Mailing Address
First Line	:	310 N LARCH AVE
Second Line	:
City	:	STAYTON
State	:	OR
Zip	:	97383-1556
Country	:	US
Telephone Number	:	503-507-6443
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 WATER ST NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-6467
Country	:	US
Telephone Number	:	503-507-6443
Fax Number	:

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

Provider Enumeration Date	:	03/01/2019
Last Update Date	:	03/01/2019

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