Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 359521 | OR |
NPI | 1063961159 |
---|---|
Provider Name | Jessica Eggers |
First Address | Beaverton, OR 97006-8518 |
Second Address | Hillsboro, OR 97124-5806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2016 |
Last Update Date | 29/09/2016 |