Provider Demographics
NPI:1619433968
Name:DAILY, KAITLYN R (LMT)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:R
Last Name:DAILY
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 1:21707 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-2029
Mailing Address - Country:US
Mailing Address - Phone:971-570-5814
Mailing Address - Fax:866-454-3512
Practice Address - Street 1:501 NE HOOD AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030
Practice Address - Country:US
Practice Address - Phone:503-674-7894
Practice Address - Fax:503-674-7899
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24641225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist