MEDICARE: PT & OT OF OREGON, LLC

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

General Provider Information

NPI Number	:	1396957817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PT & OT OF OREGON, LLC

Provider Business Mailing Address
First Line	:	18801 37TH AVE NE
Second Line	:
City	:	LAKE FOREST PARK
State	:	WA
Zip	:	98155-2713
Country	:	US
Telephone Number	:	206-367-5853
Fax Number	:	206-367-9609

Provider Business Practice Location Address
First Line	:	4305 SE MILWAUKIE AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-3960
Country	:	US
Telephone Number	:	503-232-3955
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. GREGORY LEE WHITE
Credential	:
Telephone Number	:	206-367-5853

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	08/22/2020

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