Provider Demographics
NPI:1437426202
Name:OSTROM, THERESA A (LMT)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:A
Last Name:OSTROM
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 1:11280 HWY 66
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-9080
Mailing Address - Country:US
Mailing Address - Phone:541-591-1868
Mailing Address - Fax:
Practice Address - Street 1:11280 HWY 66
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-9080
Practice Address - Country:US
Practice Address - Phone:541-591-1868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10071225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist