Provider Demographics
NPI:1043593320
Name:SAXBY, DEBORAH RUTH
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:RUTH
Last Name:SAXBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:RUTH
Other - Last Name:ESHELBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 273
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-0273
Mailing Address - Country:US
Mailing Address - Phone:503-917-9434
Mailing Address - Fax:
Practice Address - Street 1:289 E ELLENDALE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1580
Practice Address - Country:US
Practice Address - Phone:503-917-9434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16827174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR16827OtherMASSAGE THERAPIST