Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 985863 | OR |
NPI | 1073854311 |
---|---|
Provider Name | Karla B Yates |
First Address | Terrebonne, OR 97760 |
Second Address | Tigard, OR 97223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2013 |
Last Update Date | 12/03/2013 |