Provider Demographics
NPI:1114269883
Name:MURDOCK, KAILEE MICHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:KAILEE
Middle Name:MICHELLE
Last Name:MURDOCK
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 1:21550 NW GILKISON RD
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-8506
Mailing Address - Country:US
Mailing Address - Phone:971-221-4375
Mailing Address - Fax:
Practice Address - Street 1:2155 NW 173RD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-3563
Practice Address - Country:US
Practice Address - Phone:503-352-0735
Practice Address - Fax:503-352-0734
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18082225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist