Provider Demographics
NPI:1598392862
Name:EVERETT, DAWNIELLE (LMT)
Entity Type:Individual
Prefix:
First Name:DAWNIELLE
Middle Name:
Last Name:EVERETT
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 1:4029 NE 16TH CT
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-4676
Mailing Address - Country:US
Mailing Address - Phone:503-756-3898
Mailing Address - Fax:
Practice Address - Street 1:2820 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-7068
Practice Address - Country:US
Practice Address - Phone:971-317-0883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24243225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR24243OtherLICENSED MASSAGE THERAPIST