Provider Demographics
NPI:1154525871
Name:MCKITRICK, MAURI (LMT)
Entity type:Individual
Prefix:
First Name:MAURI
Middle Name:
Last Name:MCKITRICK
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 1:4130 NE 54TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-2110
Mailing Address - Country:US
Mailing Address - Phone:971-506-4560
Mailing Address - Fax:
Practice Address - Street 1:2928 SE HAWTHORNE BLVD
Practice Address - Street 2:#104
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4147
Practice Address - Country:US
Practice Address - Phone:971-506-4560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8161171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor