Provider Demographics
NPI:1275856007
Name:STRIVENS, KATHLEEN ELEANOR (MT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ELEANOR
Last Name:STRIVENS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:MRS
Other - First Name:KATHY
Other - Middle Name:ELEANOR
Other - Last Name:STRIVENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MT
Mailing Address - Street 1:4955 SW 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-1844
Mailing Address - Country:US
Mailing Address - Phone:503-260-0909
Mailing Address - Fax:
Practice Address - Street 1:4955 SW 76TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-1844
Practice Address - Country:US
Practice Address - Phone:503-260-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4886173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist