Provider Demographics
NPI:1558666008
Name:SEGURA-WHITMAN, KATHERINE M (LMT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:SEGURA-WHITMAN
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 1:461 NE GREENWOOD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4607
Mailing Address - Country:US
Mailing Address - Phone:541-241-3135
Mailing Address - Fax:971-256-8865
Practice Address - Street 1:461 NE GREENWOOD AVE STE A
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701
Practice Address - Country:US
Practice Address - Phone:541-241-3135
Practice Address - Fax:971-256-8865
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17879225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR17879OtherSTATE OF OREGON