Provider Demographics
NPI:1437404910
Name:KENT, KAREN PEARL AGNES (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:PEARL AGNES
Last Name:KENT
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 1:4154 CALAROGA CIR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-1005
Mailing Address - Country:US
Mailing Address - Phone:503-702-8043
Mailing Address - Fax:
Practice Address - Street 1:8230 SW BARBUR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2843
Practice Address - Country:US
Practice Address - Phone:503-702-8043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18303225700000X
CAL9790374700000X
OR155744374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist