Provider Demographics
NPI:1366707572
Name:KATIE MARSHALL, L.AC.
Entity type:Organization
Organization Name:KATIE MARSHALL, L.AC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:KELLEY
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-754-9443
Mailing Address - Street 1:3808 N WILLIAMS AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1467
Mailing Address - Country:US
Mailing Address - Phone:503-754-9443
Mailing Address - Fax:503-388-9124
Practice Address - Street 1:3808 N WILLIAMS AVE
Practice Address - Street 2:SUITE F
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1467
Practice Address - Country:US
Practice Address - Phone:503-754-9443
Practice Address - Fax:503-388-9124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC153430171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty