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General NPI Number Information
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NPI Number | 1831373539
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Entity Type | Individual
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Provider Name | DEBRA RAE ODEN LMT
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Gender | Female
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Dates
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Enumeration Date | 12/18/2007
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Last Update Date | 11/06/2019
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Provider Practice Location Address
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Address Line | 8538 SW APPLEWAY
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City | PORTLAND
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State | OR
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Zip | 97225
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Country | US
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Telephone | 503-520-8743
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Fax |
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Provider Business Mailing Address
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Address Line | 6711 N. AMHERST DR
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City | PORTAND
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State | OR
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Zip | 97203
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Country | US
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Telephone | 503-910-5717
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146N00000X
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Taxonomy Name | Basic Emergency Medical Technician
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License Number | 203005
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 8030
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License Number State | OR
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