Provider Demographics
NPI:1497110761
Name:EMI K ODA, LMT
Entity Type:Organization
Organization Name:EMI K ODA, LMT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMI
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:ODA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:540-908-0689
Mailing Address - Street 1:21512 NW MIRIAM WAY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97006-1009
Mailing Address - Country:US
Mailing Address - Phone:540-908-0689
Mailing Address - Fax:
Practice Address - Street 1:5215 NE ELAM YOUNG PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6498
Practice Address - Country:US
Practice Address - Phone:540-908-0689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20422225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty