Provider Demographics
NPI:1326529793
Name:MARTELL, KATELYN (DPT)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:MARTELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 592
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-0592
Mailing Address - Country:US
Mailing Address - Phone:503-723-5049
Mailing Address - Fax:
Practice Address - Street 1:1554 GARDEN ST STE 103
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-3278
Practice Address - Country:US
Practice Address - Phone:503-723-0347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62925225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist