Provider Demographics
NPI:1083960462
Name:TAYLOR, DEBBIE SUE (LMT)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:SUE
Last Name:TAYLOR
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 1:875 SW VIEW CREST DR
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:OR
Mailing Address - Zip Code:97115-8505
Mailing Address - Country:US
Mailing Address - Phone:503-267-8273
Mailing Address - Fax:
Practice Address - Street 1:2501 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1965
Practice Address - Country:US
Practice Address - Phone:503-267-8273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18739225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR18739OtherLICENSED MASSAGE THERAPIST