Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 1063683 | OR |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5665 | CA |
NPI | 1073827812 |
---|---|
Provider Name | Trenton Michael Smith |
First Address | West Linn, OR 97068-2801 |
Second Address | Wilsonville, OR 97070-9697 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2010 |
Last Update Date | 28/04/2011 |