Provider Demographics
NPI:1073057816
Name:RACHEL, ANNA (LMP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:RACHEL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6317 NE 47TH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-1844
Mailing Address - Country:US
Mailing Address - Phone:503-516-9645
Mailing Address - Fax:
Practice Address - Street 1:406 SE 131ST AVE
Practice Address - Street 2:108
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4004
Practice Address - Country:US
Practice Address - Phone:360-944-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60704358225700000X
OR22821225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist