Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 393462 | OR |
N | 225XH1200X | Occupational Therapist - Hand | OT00002214 | WA |
NPI | 1215910948 |
---|---|
Provider Name | Julie E Teal |
First Address | Portland, OR 97210-3442 |
Second Address | Portland, OR 97210-3442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0055250 | WA L&I (01) | WA |
021423 | (05) | OR |
8434615 | (05) | WA |