Provider Demographics
NPI:1164692281
Name:CLAUS, LORETTA N (LMT)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:N
Last Name:CLAUS
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 1:15405 SW 116TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KING CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97224-2600
Mailing Address - Country:US
Mailing Address - Phone:503-624-9680
Mailing Address - Fax:
Practice Address - Street 1:15405 SW 116TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:KING CITY
Practice Address - State:OR
Practice Address - Zip Code:97224-2600
Practice Address - Country:US
Practice Address - Phone:503-624-9680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2578225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR2578OtherOBMT
OR445566-00OtherNCBTMB