Provider Demographics
NPI:1659630267
Name:RAPPAPORT, DEBORAH (DEBI) (LMT 13155)
Entity Type:Individual
Prefix:
First Name:DEBORAH (DEBI)
Middle Name:
Last Name:RAPPAPORT
Suffix:
Gender:F
Credentials:LMT 13155
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 955
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-0955
Mailing Address - Country:US
Mailing Address - Phone:541-973-5779
Mailing Address - Fax:
Practice Address - Street 1:88 LAPREE ST
Practice Address - Street 2:
Practice Address - City:TALENT
Practice Address - State:OR
Practice Address - Zip Code:97540-6000
Practice Address - Country:US
Practice Address - Phone:541-973-5779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13155225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR13155OtherSTATE OF OREGON MASSAGE LICENSING BOARD
IL335888-00OtherNCBTMB (NATIONAL CERTIFICATION BOARD THERAPEUTIC MASSAGE & BODYWORK)