Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 524207 | OR |
NPI | 1023593258 |
---|---|
Provider Name | Paul D Zulak |
First Address | Portland, OR 97225-6683 |
Second Address | Portland, OR 97225-6683 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2018 |
Last Update Date | 03/10/2018 |