Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 388113 | OR |
N | 225XG0600X | Occupational Therapist - Gerontology | 388113 | OR |
NPI | 1689198814 |
---|---|
Provider Name | Claudia Anukam |
First Address | Clackamas, OR 97015-9241 |
Second Address | Gresham, OR 97030-7345 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2017 |
Last Update Date | 30/07/2017 |