Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 338615 | OR |
NPI | 1508239377 |
---|---|
Provider Name | Marcy Jean Phillips |
First Address | Milwaukie, OR 97222-4242 |
Second Address | Milwaukie, OR 97222-4242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2015 |
Last Update Date | 02/11/2015 |