Provider Demographics
NPI:1225282254
Name:KOHL, LINDA MAE (LMT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MAE
Last Name:KOHL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:MAE
Other - Last Name:KOHL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:2600 N RUSSET ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-6244
Mailing Address - Country:US
Mailing Address - Phone:503-285-7960
Mailing Address - Fax:
Practice Address - Street 1:1920 NW JOHNSON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1325
Practice Address - Country:US
Practice Address - Phone:503-274-0644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4136225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist