Provider Demographics
NPI:1215270517
Name:DE LA MOTTE, ANYA (ND)
Entity type:Individual
Prefix:
First Name:ANYA
Middle Name:
Last Name:DE LA MOTTE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 SW SHEVLIN HIXON DR STE 201
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3233
Mailing Address - Country:US
Mailing Address - Phone:541-321-0164
Mailing Address - Fax:
Practice Address - Street 1:151 SW SHEVLIN HIXON DR STE 201
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3233
Practice Address - Country:US
Practice Address - Phone:541-321-0164
Practice Address - Fax:541-508-5461
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4314175F00000X
VT099.0093786175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath