Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 914163 | OR |
NPI | 1417119967 |
---|---|
Provider Name | Mrs. Kimberly Shawn O'grady |
First Address | Eugene, OR 97405-1798 |
Second Address | Eugene, OR 97405-1798 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 26/06/2008 |