Healthcare Provider Details

I. General information

NPI: 1356392336
Provider Name (Legal Business Name): DEBRA ELLEN SIMERAL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 07/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 RATCLIFF DR SE
SALEM OR
97302-4581
US

IV. Provider business mailing address

1213 E VIRGINIA ST
STAYTON OR
97383-2076
US

V. Phone/Fax

Practice location:
  • Phone: 503-931-2077
  • Fax:
Mailing address:
  • Phone: 503-931-2077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11436
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: