Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1056485 | OR |
NPI | 1003082470 |
---|---|
Provider Name | Patricia Jean Moursalian |
First Address | Mount Angel, OR 97362-9540 |
Second Address | Mount Angel, OR 97362-9540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2008 |
Last Update Date | 05/05/2008 |