Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 367023 | OR |
Y | 225XM0800X | Mental Health | 367023 | OR |
NPI | 1689040149 |
---|---|
Provider Name | Michelle De Oliveira |
First Address | Mcminnville, OR 97128-3923 |
Second Address | Portland, OR 97229-5442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2015 |
Last Update Date | 17/03/2018 |