Provider Demographics
NPI:1194015610
Name:HIMES, AMBER (LMT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:HIMES
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 1:17949 NW EVERGREEN PKWY
Mailing Address - Street 2:UNIT 100
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7693
Mailing Address - Country:US
Mailing Address - Phone:503-319-7258
Mailing Address - Fax:
Practice Address - Street 1:4805 SW OLESON RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-1420
Practice Address - Country:US
Practice Address - Phone:503-319-7258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14056225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist