Provider Demographics
NPI:1073751020
Name:NELLI, DEBORA K (LMT)
Entity Type:Individual
Prefix:MS
First Name:DEBORA
Middle Name:K
Last Name:NELLI
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 1:4070 SW 107TH AVE # 7
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3171
Mailing Address - Country:US
Mailing Address - Phone:425-802-3809
Mailing Address - Fax:
Practice Address - Street 1:7417 SW BEAVERTON HILLSDALE HWY STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-2100
Practice Address - Country:US
Practice Address - Phone:503-291-7155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13645225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist