Provider Demographics
NPI:1922562891
Name:REYES, DEVON L (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DEVON
Middle Name:L
Last Name:REYES
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 1:6805 AIRWAY DR APT C
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-9490
Mailing Address - Country:US
Mailing Address - Phone:541-591-0821
Mailing Address - Fax:
Practice Address - Street 1:3815 S 6TH ST STE 160
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4075
Practice Address - Country:US
Practice Address - Phone:541-850-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21536225700000X
21536225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty