MEDICARE: GINGER ELIZABETH EBERT MOTR/L

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	234790	OR

General Provider Information

NPI Number	:	1417275066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINGER ELIZABETH EBERT MOTR/L

Provider Business Mailing Address
First Line	:	3030 NE 31ST AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-3658
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 NE 31ST AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-3658
Country	:	US
Telephone Number	:	503-449-3656
Fax Number	:

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

Provider Enumeration Date	:	05/06/2010
Last Update Date	:	05/06/2010

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