Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 2535 | OR |
NPI | 1174810006 |
---|---|
Provider Name | Dona D Johnson |
First Address | Portland, OR 97203-1097 |
Second Address | Lake Oswego, OR 97034-6605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2011 |
Last Update Date | 29/06/2011 |