Provider Demographics
NPI:1508919838
Name:KAHLIE, CATHEY MAE (MS PT)
Entity Type:Individual
Prefix:MRS
First Name:CATHEY
Middle Name:MAE
Last Name:KAHLIE
Suffix:
Gender:F
Credentials:MS PT
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Mailing Address - Street 1:2275 NE DOCTORS DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6324
Mailing Address - Country:US
Mailing Address - Phone:541-382-5500
Mailing Address - Fax:541-389-5669
Practice Address - Street 1:336 SW CYBER DR
Practice Address - Street 2:SUITE 107
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702
Practice Address - Country:US
Practice Address - Phone:541-382-5500
Practice Address - Fax:541-389-5669
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2012-05-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OR2365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274012Medicaid
ORR158427Medicare PIN
OR114780Medicare ID - Type Unspecified