Provider Demographics
NPI:1548708050
Name:KAETER, LAURA E (LMT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:KAETER
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 1:3011 NE EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6905
Mailing Address - Country:US
Mailing Address - Phone:619-564-0644
Mailing Address - Fax:
Practice Address - Street 1:15220 NW GREENBRIER PKWY STE 260
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-8111
Practice Address - Country:US
Practice Address - Phone:503-439-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22062225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist