Provider Demographics
NPI:1295923431
Name:HUTTEMA, DEVON LEIGH (LMT)
Entity type:Individual
Prefix:MRS
First Name:DEVON
Middle Name:LEIGH
Last Name:HUTTEMA
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 1:6201 CASTLE TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-9703
Mailing Address - Country:US
Mailing Address - Phone:541-941-8623
Mailing Address - Fax:
Practice Address - Street 1:990 S FRONT ST
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2727
Practice Address - Country:US
Practice Address - Phone:541-664-5253
Practice Address - Fax:541-664-1165
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12769174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist