Provider Demographics
NPI:1508986365
Name:KAPPEL, OLIVIA M (LMT, CST, NUT)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:M
Last Name:KAPPEL
Suffix:
Gender:F
Credentials:LMT, CST, NUT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 N 1ST ST
Mailing Address - Street 2:STE C
Mailing Address - City:LAKEVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97630-1506
Mailing Address - Country:US
Mailing Address - Phone:541-947-5011
Mailing Address - Fax:541-947-5013
Practice Address - Street 1:628 N 1ST ST
Practice Address - Street 2:STE C
Practice Address - City:LAKEVIEW
Practice Address - State:OR
Practice Address - Zip Code:97630-1506
Practice Address - Country:US
Practice Address - Phone:541-947-5011
Practice Address - Fax:541-947-5013
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1667247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1667OtherSTATE LICENSE NUMBER