MEDICARE: DEBBIE KAY DODGE OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	233320	OR

General Provider Information

NPI Number	:	1184728172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBBIE KAY DODGE OT

Provider Business Mailing Address
First Line	:	1815 SW MARLOW
Second Line	:	SUITE 110
City	:	PORTLAND
State	:	OR
Zip	:	97225-5185
Country	:	US
Telephone Number	:	503-292-0765
Fax Number	:	503-292-5208

Provider Business Practice Location Address
First Line	:	1815 SW MARLOW
Second Line	:	SUITE 110
City	:	PORTLAND
State	:	OR
Zip	:	97225-5185
Country	:	US
Telephone Number	:	503-292-0765
Fax Number	:	503-292-5208

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	07/08/2007

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