Provider Demographics
NPI:1730948589
Name:KLEINER, DERRICK (CPO)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:
Last Name:KLEINER
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 UNION AVE STE C
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5861
Mailing Address - Country:US
Mailing Address - Phone:541-955-9678
Mailing Address - Fax:541-471-4909
Practice Address - Street 1:300 UNION AVE STE C
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5861
Practice Address - Country:US
Practice Address - Phone:541-955-9678
Practice Address - Fax:541-471-4909
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist