Provider Demographics
NPI:1407397680
Name:BUXTON, KATLYN
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:
Last Name:BUXTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7993 SE MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-1443
Mailing Address - Country:US
Mailing Address - Phone:606-875-8812
Mailing Address - Fax:
Practice Address - Street 1:22000 WILLAMETTE DR
Practice Address - Street 2:107
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-3275
Practice Address - Country:US
Practice Address - Phone:503-722-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22803172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist