Mauri McKitrick, LMT
Individual provider Active NPI Contractor · Portland, OR
NPI 1154525871 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1154525871
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 8161 (OR)
- Practice address
- 2928 SE Hawthorne Blvd
#104
Portland, OR 97214-4147 - Phone
- (971) 506-4560
- NPI assigned
- Jun 14, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8161 | OR | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 8161 | OR | Yes |
Addresses
Primary practice location
2928 SE Hawthorne Blvd
#104
Portland, OR 97214-4147
Mailing address
4130 NE 54TH Ave
Portland, OR 97218-2110
Phone (971) 506-4560
Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.