Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 982232 | OR |
NPI | 1033694674 |
---|---|
Provider Name | Lisa Woodworth |
First Address | Portland, OR 97229-2864 |
Second Address | Portland, OR 97225-6683 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2018 |
Last Update Date | 29/09/2018 |