Provider Demographics
NPI:1336712983
Name:KNOWLES, KATHERINE LESLIE (LMT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LESLIE
Last Name:KNOWLES
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 1:2475 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2256
Mailing Address - Country:US
Mailing Address - Phone:541-342-6436
Mailing Address - Fax:
Practice Address - Street 1:2475 JACKSON ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2256
Practice Address - Country:US
Practice Address - Phone:541-342-6436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2617225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist