Provider Demographics
NPI:1447482864
Name:MCKEE, BERNADETTE TERESA (LMT)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:TERESA
Last Name:MCKEE
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 1:19022 OLD RIVER DR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-1041
Mailing Address - Country:US
Mailing Address - Phone:503-522-8316
Mailing Address - Fax:
Practice Address - Street 1:19022 OLD RIVER DR
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-1041
Practice Address - Country:US
Practice Address - Phone:503-522-8316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15289225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist