Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-56283 | OR |
NPI | 1255711032 |
---|---|
Provider Name | Rose Otter |
First Address | Portland, OR 97214-3191 |
Second Address | Portland, OR 97214-3191 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2015 |
Last Update Date | 05/06/2015 |