Provider Demographics
NPI:1013312347
Name:NELSON, ANNABETH R (LMT)
Entity Type:Individual
Prefix:MS
First Name:ANNABETH
Middle Name:R
Last Name:NELSON
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 1:311 EDGEWOOD DR
Mailing Address - Street 2:PO BOX 994
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-2211
Mailing Address - Country:US
Mailing Address - Phone:503-569-2284
Mailing Address - Fax:
Practice Address - Street 1:895 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-2243
Practice Address - Country:US
Practice Address - Phone:503-874-2503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11206225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist