Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OR |
NPI | 1003902941 |
---|---|
Provider Name | Mrs. Susan Gorthey Bottomley |
First Address | Corvallis, OR 97330-3891 |
Second Address | Corvallis, OR 97330-3891 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |