Provider Demographics
NPI:1487178612
Name:ARCHER, DEVORA (LMT)
Entity type:Individual
Prefix:
First Name:DEVORA
Middle Name:
Last Name:ARCHER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:JEANNE
Other - Last Name:NEFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:6529 SE 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-7511
Mailing Address - Country:US
Mailing Address - Phone:850-499-2108
Mailing Address - Fax:
Practice Address - Street 1:2122 NW QUIMBY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2622
Practice Address - Country:US
Practice Address - Phone:503-292-7668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-30
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23314225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist