Provider Demographics
NPI:1417835968
Name:REMINGTON, KAEGAN L
Entity type:Individual
Prefix:
First Name:KAEGAN
Middle Name:L
Last Name:REMINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4934 BEAVER POND CT NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-2823
Mailing Address - Country:US
Mailing Address - Phone:503-798-7539
Mailing Address - Fax:
Practice Address - Street 1:4934 BEAVER POND CT NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-2823
Practice Address - Country:US
Practice Address - Phone:503-798-7539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health