Provider Demographics
NPI:1982005344
Name:KAIL, CASSANDRA (LMT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:KAIL
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 1:5528 SE LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-2946
Mailing Address - Country:US
Mailing Address - Phone:503-548-7837
Mailing Address - Fax:
Practice Address - Street 1:3808 N WILLIAMS AVE
Practice Address - Street 2:SUITE F
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1467
Practice Address - Country:US
Practice Address - Phone:503-548-7837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20675225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist