Provider Demographics
NPI:1861096190
Name:CUTTLER, KRISTIANA MARIE (LMT)
Entity type:Individual
Prefix:
First Name:KRISTIANA
Middle Name:MARIE
Last Name:CUTTLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KRISTIANA
Other - Middle Name:MARIE SCHMIDT
Other - Last Name:CUTTLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4924 SE LOGUS RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-5156
Mailing Address - Country:US
Mailing Address - Phone:415-845-3444
Mailing Address - Fax:
Practice Address - Street 1:4924 SE LOGUS RD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-5156
Practice Address - Country:US
Practice Address - Phone:415-845-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24959225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist