Provider Demographics
NPI:1659492296
Name:BURTON, MOLLY K (LMT)
Entity type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:K
Last Name:BURTON
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 1:562 NW 19TH PL
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-8800
Mailing Address - Country:US
Mailing Address - Phone:541-923-4706
Mailing Address - Fax:541-923-4706
Practice Address - Street 1:562 NW 19TH PL
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-8800
Practice Address - Country:US
Practice Address - Phone:541-923-4706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4538246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other