Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1060547 | OR |
NPI | 1003075417 |
---|---|
Provider Name | Nicole Tognoli |
First Address | Sherwood, OR 97140-9178 |
Second Address | Newberg, OR 97132-1806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2008 |
Last Update Date | 02/06/2008 |