Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 2501 | OR |
NPI | 1275772121 |
---|---|
Provider Name | Erin Boyll |
First Address | Canby, OR 97013-2490 |
Second Address | Tigard, OR 97224-3446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2009 |
Last Update Date | 17/02/2009 |