Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 13630 | CA |
N | 225XP0200X | Occupational Therapist - Pediatrics | 13630 | CA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 275463 | OR |
NPI | 1063821528 |
---|---|
Provider Name | Laura Mascola |
First Address | Portland, OR 97212-2356 |
Second Address | Portland, OR 97212-2356 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2014 |
Last Update Date | 27/10/2020 |