Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 332953 | OR |
NPI | 1700282811 |
---|---|
Provider Name | Michael Whitty |
First Address | Wilsonville, OR 97070-9697 |
Second Address | Hillsboro, OR 97123-4120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2014 |
Last Update Date | 17/11/2014 |