Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 1003226 | OR |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 1003226 | OR |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 1003226 | OR |
NPI | 1144667502 |
---|---|
Provider Name | Camille Gifford |
First Address | Lake Oswego, OR 97035-4587 |
Second Address | Lake Oswego, OR 97035-4587 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2013 |
Last Update Date | 25/05/2013 |