| Provider / Organization | NPI | Date Certified |
|---|---|---|
| TERRIE LYNNE KLOTZ | 1295323715 | 2021-01-10 |
| Entity Type | Individual |
| Provider Name | Terrie Lynne Klotz |
| Practice Office Address | 21185 NW WEST UNION RD HILLSBORO, OR US |
| Practice Office Telephone | 5032069472 |
| Mailing Address | 4890 NW NESKOWIN AVE PORTLAND, OR 97229 US |
| Business Telephone | 5032069472 |
| Code | License No | State |
|---|---|---|
| 246ZA2600X PRIMARY | BAP-TA-792578 | OR |
| 193400000X SING | Group Code |