Provider Demographics
NPI:1790093433
Name:MCDONALD, KATHLEEN WARNER (MA, LMT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:WARNER
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9265 SW 8TH DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-4753
Mailing Address - Country:US
Mailing Address - Phone:503-869-8429
Mailing Address - Fax:
Practice Address - Street 1:2400 SW VERMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-1940
Practice Address - Country:US
Practice Address - Phone:503-452-0915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1781225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist