Provider Demographics
NPI:1417270596
Name:MADDEN, KRISTIN ANN (LMT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANN
Last Name:MADDEN
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 1:22000 WILLAMETTE DR
Mailing Address - Street 2:#107
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-3275
Mailing Address - Country:US
Mailing Address - Phone:503-722-8888
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?:No
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16192225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist