Individual
DEBRA RAE ODEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
8538 SW APPLEWAY, PORTLAND, OR 97225
(503) 520-8743
Mailing address
6711 N. AMHERST DR, PORTAND, OR 97203
(503) 910-5717
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
203005
OR
225700000X
Massage Therapist
Primary
8030
OR
Other
Enumeration date
12/18/2007
Last updated
11/06/2019
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