Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 342806 | OR |
NPI | 1912485962 |
---|---|
Provider Name | Jessie Tefft |
First Address | Portland, OR 97225-6648 |
Second Address | Portland, OR 97225-6648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2018 |
Last Update Date | 01/08/2018 |