Healthcare Provider Details

I. General information

NPI: 1982467924
Provider Name (Legal Business Name): RISE UP PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25060 CULTUS LN
BEND OR
97701-9638
US

IV. Provider business mailing address

25060 CULTUS LN
BEND OR
97701-9638
US

V. Phone/Fax

Practice location:
  • Phone: 207-807-7147
  • Fax:
Mailing address:
  • Phone: 207-807-7147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: SARAH LINDEN
Title or Position: OCCUPATIONAL THERAPIST
Credential: MOT, OTR/L
Phone: 207-807-7147