Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 309530 | OR |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 309530 | OR |
NPI | 1346790268 |
---|---|
Provider Name | Ingrid Borland |
First Address | Portland, OR 97212-3827 |
Second Address | Portland, OR 97212-3827 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2016 |
Last Update Date | 27/01/2021 |