Provider Demographics
NPI:1205903606
Name:AMARA, DEBORA A (MA,OTR)
Entity type:Individual
Prefix:MS
First Name:DEBORA
Middle Name:A
Last Name:AMARA
Suffix:
Gender:F
Credentials:MA,OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15715 NW RYEGRASS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-9289
Mailing Address - Country:US
Mailing Address - Phone:503-690-4844
Mailing Address - Fax:
Practice Address - Street 1:620 SE OAK ST STE A
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4160
Practice Address - Country:US
Practice Address - Phone:503-844-6565
Practice Address - Fax:503-844-4225
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR914565225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR167872Medicaid
OR110240Medicare PIN