Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 364552 | OR |
N | 225XP0200X | Occupational Therapist - Pediatrics | 084244 | IA |
NPI | 1073061750 |
---|---|
Provider Name | Hannah C Filicky |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97225-6643 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2016 |
Last Update Date | 12/02/2021 |