Provider Demographics
NPI:1013206390
Name:MARSHALL, KATHERINE KELLEY (LAC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:KELLEY
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6855
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97228
Mailing Address - Country:US
Mailing Address - Phone:503-754-9443
Mailing Address - Fax:
Practice Address - Street 1:3808 N WILLIAMS AVE STE F
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1468
Practice Address - Country:US
Practice Address - Phone:503-754-9443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR153430171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist