Provider Demographics
NPI:1528343837
Name:ROUTSON, MOLLY KATE (LMT)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:KATE
Last Name:ROUTSON
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 1:1012 TREVITT ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-1463
Mailing Address - Country:US
Mailing Address - Phone:541-296-6495
Mailing Address - Fax:541-296-6497
Practice Address - Street 1:1012 TREVITT ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-1463
Practice Address - Country:US
Practice Address - Phone:541-296-6495
Practice Address - Fax:541-296-6497
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18414174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist