Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 4402 | OR |
N | 2251N0400X | Physical Therapist - Neurology | 4402 | OR |
NPI | 1396108775 |
---|---|
Provider Name | Mrs. Jamie Caulley |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97213-2982 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2016 |
Last Update Date | 01/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500709568 | (05) | OR |