Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 328753 | OR |
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT 60490276 | WA |
NPI | 1235509647 |
---|---|
Provider Name | Nicholas Horton |
First Address | Portland, OR 97212-3924 |
Second Address | Portland, OR 97212-3924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2015 |
Last Update Date | 28/09/2015 |