1346548401 NPI number — KATE LARSON LMT

Table of content: KATE LARSON LMT (NPI 1346548401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346548401 NPI number — KATE LARSON LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARSON
Provider First Name:
KATE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LARSON
Provider Other First Name:
KATHARIN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1346548401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6073 BETHEL LOOP SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97321-3602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-357-2488
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 SW MADISON AVE
Provider Second Line Business Practice Location Address:
SUITE W
Provider Business Practice Location Address City Name:
CORVALLIS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97333-4799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-357-2488
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  17952 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 828951 . This is a "ABMP" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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