Healthcare Provider Details

I. General information

NPI: 1871099358
Provider Name (Legal Business Name): AMY WILLISON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22018 S CENTRAL POINT RD
CANBY OR
97013-8705
US

IV. Provider business mailing address

75 C ST APT 207
INDEPENDENCE OR
97351-2063
US

V. Phone/Fax

Practice location:
  • Phone: 503-221-4531
  • Fax:
Mailing address:
  • Phone: 240-522-7762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number397472
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: