Provider Demographics
NPI:1609161314
Name:KALKOSKE, LIBBY ANN (LMT)
Entity Type:Individual
Prefix:
First Name:LIBBY
Middle Name:ANN
Last Name:KALKOSKE
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 1:1129 SW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-3021
Mailing Address - Country:US
Mailing Address - Phone:541-903-0894
Mailing Address - Fax:
Practice Address - Street 1:1129 SW 12TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-3021
Practice Address - Country:US
Practice Address - Phone:541-903-0894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19864225700000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist