Provider Demographics
NPI:1205234242
Name:CONLIN, KELLY K (LMT)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:K
Last Name:CONLIN
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 1:1025 SW 11TH AVE
Mailing Address - Street 2:APT. 31
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2056
Mailing Address - Country:US
Mailing Address - Phone:917-331-1045
Mailing Address - Fax:
Practice Address - Street 1:1017 SW MORRISON ST
Practice Address - Street 2:STE 403
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205
Practice Address - Country:US
Practice Address - Phone:503-893-2913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-08
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20794225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist