Provider Demographics
NPI:1962672634
Name:AKERS, ASHLEY NICOLE (LMT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICOLE
Last Name:AKERS
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 1:289 E ELLENDALE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-1580
Mailing Address - Country:US
Mailing Address - Phone:503-623-5505
Mailing Address - Fax:
Practice Address - Street 1:289 E ELLENDALE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1580
Practice Address - Country:US
Practice Address - Phone:503-623-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12023225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist