Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 359496 | OR |
NPI | 1083213474 |
---|---|
Provider Name | Ross Hubbard |
First Address | Gresham, OR 97030-3376 |
Second Address | Gresham, OR 97030-3376 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2020 |
Last Update Date | 18/10/2020 |