Healthcare Provider Details

I. General information

NPI: 1194858944
Provider Name (Legal Business Name): LORI LEE LINGLE ELLING OTL CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12345 SW HORIZON BLVD STE 57
BEAVERTON OR
97007-9475
US

IV. Provider business mailing address

PO BOX 3158
PORTLAND OR
97208-3158
US

V. Phone/Fax

Practice location:
  • Phone: 503-216-8825
  • Fax:
Mailing address:
  • Phone: 503-215-6494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number000373
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: