Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 15745 | CA |
Y | 225X00000X | Occupational Therapist | OT60794368 | WA |
N | 225XH1200X | Occupational Therapist - Hand | 346828 | OR |
NPI | 1033583240 |
---|---|
Provider Name | Leslie Ann Harvell |
First Address | Portland, OR 97208-4825 |
Second Address | Vancouver, WA 98664-2002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2015 |
Last Update Date | 16/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2177601 | (05) | WA |