Provider Demographics
NPI:1053880609
Name:PARR, DEBRA JEAN (LMT/RYT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:JEAN
Last Name:PARR
Suffix:
Gender:F
Credentials:LMT/RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 MOONSHINE PARK RD
Mailing Address - Street 2:
Mailing Address - City:LOGSDEN
Mailing Address - State:OR
Mailing Address - Zip Code:97357-9704
Mailing Address - Country:US
Mailing Address - Phone:999-999-9999
Mailing Address - Fax:
Practice Address - Street 1:306 SW COAST HWY STE 200
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4903
Practice Address - Country:US
Practice Address - Phone:541-961-2716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3416225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist