Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 584 | OR |
N | 225XH1200X | Occupational Therapist - Hand | 584 | OR |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 584 | OR |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 584 | OR |
NPI | 1164631370 |
---|---|
Provider Name | Ms. Anne Marie Banasky |
First Address | Portland, OR 97266-6137 |
Second Address | Portland, OR 97239-4501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 03/04/2020 |