Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 329114 | OR |
N | 225X00000X | Occupational Therapist | OT60498956 | WA |
N | 225XG0600X | Occupational Therapist - Gerontology | 329114 | OR |
NPI | 1497146799 |
---|---|
Provider Name | Gracie Mukai |
First Address | Oregon City, OR 97045-2241 |
Second Address | Oregon City, OR 97045-2241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2015 |
Last Update Date | 18/01/2016 |