Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1058877 | OR |
N | 225XP0200X | Occupational Therapist - Pediatrics | 1058877 | OR |
NPI | 1053375436 |
---|---|
Provider Name | Mrs. Deedra Marie Weill |
First Address | Milwaukie, OR 97222 |
Second Address | Milwaukie, OR 97222 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 22/09/2008 |