Provider Demographics
NPI:1881017333
Name:KAUP, SHERRY (LMT #20244)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:
Last Name:KAUP
Suffix:
Gender:F
Credentials:LMT #20244
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5809 VALLEY VIEW RD NE
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-9704
Mailing Address - Country:US
Mailing Address - Phone:503-510-6995
Mailing Address - Fax:
Practice Address - Street 1:2744 12TH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-3159
Practice Address - Country:US
Practice Address - Phone:503-510-6995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20244225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist