Provider Demographics
NPI:1679153613
Name:FELTZ, CATHERINE MARY EMILIA (LMT)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARY EMILIA
Last Name:FELTZ
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 1:1058 RING ST NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4838
Mailing Address - Country:US
Mailing Address - Phone:503-881-1857
Mailing Address - Fax:
Practice Address - Street 1:910 CAPITOL ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1201
Practice Address - Country:US
Practice Address - Phone:594-881-1857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23880225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist