Doctor Name: | MAYA HUMPHRIES |
NPI Number: | 1235494576 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMT |
License Number: | 17687 |
Business Practice Address: | 8810 Se Sunnybrook Blvd Suite 100 Clackamas, OR - 970156843 |
Business Phone Number: | 5036072226 |
Business Fax Number: | 5036592276 |
Mailing Address: | 1375 Ne 26th St, GRESHAM |
State: | OR |
Postal Code: | 970303029 |
Phone Number: | 3609896129 |
Fax Number: | |
NPI Enumeration Date: | 07/12/2012 |
NPI Last Update Date: | 07/12/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 17687 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |