Provider Demographics
NPI:1326458704
Name:KAC, BEATRIZ (LMT)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:KAC
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 1:63099 FAIREY CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7810
Mailing Address - Country:US
Mailing Address - Phone:458-206-9647
Mailing Address - Fax:
Practice Address - Street 1:2330 NE DIVISION ST
Practice Address - Street 2:STE. 8
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-3530
Practice Address - Country:US
Practice Address - Phone:458-206-9647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20068225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist