Provider Demographics
NPI:1396056206
Name:LAWS, MARY CATHERINE (LMT)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:CATHERINE
Last Name:LAWS
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 1:517 SE 41ST AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3258
Mailing Address - Country:US
Mailing Address - Phone:314-606-5625
Mailing Address - Fax:
Practice Address - Street 1:107 SE WASHINGTON ST
Practice Address - Street 2:134
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2103
Practice Address - Country:US
Practice Address - Phone:503-236-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17197225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist