Provider Demographics
NPI:1528189727
Name:KELLY, KATE (MS,LMT)
Entity Type:Individual
Prefix:MS
First Name:KATE
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:MS,LMT
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS,LMT
Mailing Address - Street 1:1185 SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-3082
Mailing Address - Country:US
Mailing Address - Phone:541-688-7977
Mailing Address - Fax:
Practice Address - Street 1:492 E 13TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4250
Practice Address - Country:US
Practice Address - Phone:541-345-1985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2982225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist