Provider Demographics
NPI:1467293803
Name:KREEGER, MIKAYLA FAITH (LMT)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:FAITH
Last Name:KREEGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MIKAYLA
Other - Middle Name:FAITH
Other - Last Name:SIMONEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:4820 SW BARBUR BLVD APT 48
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2856
Mailing Address - Country:US
Mailing Address - Phone:808-913-4259
Mailing Address - Fax:
Practice Address - Street 1:1626 NE ALBERTA ST STE A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-5048
Practice Address - Country:US
Practice Address - Phone:503-287-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28196225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist