Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 349133 | OR |
Y | 225XM0800X | Mental Health | 349133 | OR |
NPI | 1790225712 |
---|---|
Provider Name | Dr. Elizabeth Martin |
First Address | Portland, OR 97220-1409 |
Second Address | Portland, OR 97220-1409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2017 |
Last Update Date | 12/02/2021 |