Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 430561 | OR |
NPI | 1194359315 |
---|---|
Provider Name | Teresa Sorensen |
First Address | Portland, OR 97203-3536 |
Second Address | Portland, OR 97218-2158 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2020 |
Last Update Date | 26/02/2020 |