Provider Demographics
NPI:1538647193
Name:DE VORE, ANIKA (LMT)
Entity Type:Individual
Prefix:
First Name:ANIKA
Middle Name:
Last Name:DE VORE
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 1:1020 SW TAYLOR ST STE 804
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2500
Mailing Address - Country:US
Mailing Address - Phone:503-479-8564
Mailing Address - Fax:
Practice Address - Street 1:1020 SW TAYLOR ST STE 804
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2500
Practice Address - Country:US
Practice Address - Phone:503-479-8564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-04
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24444225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist