Provider Demographics
NPI:1083888051
Name:KALEMKERIS, CHARLA (LMT)
Entity Type:Individual
Prefix:
First Name:CHARLA
Middle Name:
Last Name:KALEMKERIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 NE SANDY BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1881
Mailing Address - Country:US
Mailing Address - Phone:503-380-4953
Mailing Address - Fax:503-972-8631
Practice Address - Street 1:3800 NE SANDY BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1881
Practice Address - Country:US
Practice Address - Phone:503-380-4953
Practice Address - Fax:503-972-8631
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-21
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9755225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist