Provider Demographics
NPI:1437156460
Name:MARQUARDT, KATHLEEN A (PT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:A
Last Name:MARQUARDT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33423 SW LADD HILL RD
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-7548
Mailing Address - Country:US
Mailing Address - Phone:503-625-7954
Mailing Address - Fax:
Practice Address - Street 1:1270 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4113
Practice Address - Country:US
Practice Address - Phone:503-581-7232
Practice Address - Fax:503-581-6511
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR289892Medicaid
OR065WCHCWAMedicare ID - Type UnspecifiedPROVIDER ID#