Provider Demographics
NPI:1710120092
Name:MALBIN-WILLIAMS, ANYA NADEJDA
Entity Type:Individual
Prefix:
First Name:ANYA
Middle Name:NADEJDA
Last Name:MALBIN-WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANYA
Other - Middle Name:NADEJDA
Other - Last Name:MALBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31084 PITTSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-9136
Mailing Address - Country:US
Mailing Address - Phone:503-442-1673
Mailing Address - Fax:
Practice Address - Street 1:31084 PITTSBURG RD
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-9136
Practice Address - Country:US
Practice Address - Phone:503-442-1673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15471225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR15471OtherOREGON BOARD OF MASSAGE