Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 274591 | OR |
NPI | 1578938692 |
---|---|
Provider Name | Kitty Yan |
First Address | Lake Oswego, OR 97034-1510 |
Second Address | Portland, OR 97239-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2015 |
Last Update Date | 02/12/2015 |