Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H7935 | OR |
NPI | 1033769146 |
---|---|
Provider Name | Kaylee Ann Perlichek |
First Address | Tualatin, OR 97062-8326 |
Second Address | Salem, OR 97301-1882 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2019 |
Last Update Date | 19/09/2019 |