Provider Demographics
NPI:1740829563
Name:BOXX, KATHLEEN (RD, LD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BOXX
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:THROOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:MAUPIN
Mailing Address - State:OR
Mailing Address - Zip Code:97037-0118
Mailing Address - Country:US
Mailing Address - Phone:541-460-8830
Mailing Address - Fax:
Practice Address - Street 1:499 1ST ST
Practice Address - Street 2:
Practice Address - City:MAUPIN
Practice Address - State:OR
Practice Address - Zip Code:97037-9250
Practice Address - Country:US
Practice Address - Phone:541-460-8830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-26
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10204498133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered