Provider Demographics
NPI:1255751392
Name:STEWART, KAYLA (LMT)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:STEWART
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 1:0315 SW IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3528
Mailing Address - Country:US
Mailing Address - Phone:541-954-4963
Mailing Address - Fax:
Practice Address - Street 1:2403 SE MONROE ST STE B
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7646
Practice Address - Country:US
Practice Address - Phone:541-954-4963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15828225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist