Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 410524 | OR |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 410524 | OR |
NPI | 1003383290 |
---|---|
Provider Name | Elise M Bowlby |
First Address | Corvallis, OR 97330-3474 |
Second Address | Portland, OR 97239-6103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2018 |
Last Update Date | 07/11/2020 |