Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 297644 | OR |
N | 225XM0800X | Mental Health | 297644 | OR |
NPI | 1447621636 |
---|---|
Provider Name | Victoria May Eaton |
First Address | Hillsboro, OR 97123-4216 |
Second Address | Portland, OR 97205-1945 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2015 |
Last Update Date | 13/10/2015 |