Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 0364 | OR |
NPI | 1013169978 |
---|---|
Provider Name | Nancy Ann Cicirello |
First Address | Hillsboro, OR 97123-4218 |
Second Address | Hillsboro, OR 97123-4218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2008 |
Last Update Date | 22/10/2008 |