Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 1029792 | OR |
NPI | 1639456908 |
---|---|
Provider Name | Karen Elizabeth Nieten |
First Address | Gresham, OR 97030-5036 |
Second Address | Gresham, OR 97030-5036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2011 |
Last Update Date | 14/11/2011 |