Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | 1041669 | OR |
Y | 225XG0600X | Occupational Therapist - Gerontology | OT60631742 | WA |
NPI | 1639530041 |
---|---|
Provider Name | Danielle Marie Tollefson |
First Address | Wilsonville, OR 97070-9697 |
Second Address | Camas, WA 98607-2058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2016 |
Last Update Date | 11/03/2016 |