Provider Demographics
NPI:1326625518
Name:MACHADO, DEVRA (LMT, CIMI)
Entity Type:Individual
Prefix:
First Name:DEVRA
Middle Name:
Last Name:MACHADO
Suffix:
Gender:F
Credentials:LMT, CIMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 SEA ST # 1
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-3544
Mailing Address - Country:US
Mailing Address - Phone:774-268-1407
Mailing Address - Fax:
Practice Address - Street 1:1173 SEA ST # 1
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-3544
Practice Address - Country:US
Practice Address - Phone:774-268-1407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12801225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist