Provider Demographics
NPI:1568500338
Name:OSMUNDSON, KATHLEEN S (PT, DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:S
Last Name:OSMUNDSON
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:DR
Other - First Name:KATY
Other - Middle Name:S
Other - Last Name:OSMUNDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT, ATC
Mailing Address - Street 1:685 36TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4741
Mailing Address - Country:US
Mailing Address - Phone:503-540-8701
Mailing Address - Fax:503-371-8772
Practice Address - Street 1:685 36TH AVE NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4741
Practice Address - Country:US
Practice Address - Phone:503-371-8860
Practice Address - Fax:503-371-8772
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1600473222255A2300X
OR62435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer