Provider Demographics
NPI:1407040876
Name:MCDONALD, SIERRA LARAE (LMT)
Entity Type:Individual
Prefix:MS
First Name:SIERRA
Middle Name:LARAE
Last Name:MCDONALD
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 1:5215 NE ELAM YOUNG PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6498
Mailing Address - Country:US
Mailing Address - Phone:503-693-9101
Mailing Address - Fax:
Practice Address - Street 1:5215 NE ELAM YOUNG PKWY STE A
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6498
Practice Address - Country:US
Practice Address - Phone:503-693-9101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13260225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist