Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 251176 | OR |
NPI | 1063966463 |
---|---|
Provider Name | Cara Lee |
First Address | Portland, OR 97201-2598 |
Second Address | Portland, OR 97201-2598 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2016 |
Last Update Date | 15/08/2016 |