Healthcare Provider Details

I. General information

NPI: 1851212963
Provider Name (Legal Business Name): BETHANY PHAM OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10121 SE SUNNYSIDE RD STE 208
CLACKAMAS OR
97015-5750
US

IV. Provider business mailing address

10121 SE SUNNYSIDE RD STE 208
CLACKAMAS OR
97015-5750
US

V. Phone/Fax

Practice location:
  • Phone: 503-794-0103
  • Fax: 503-794-0104
Mailing address:
  • Phone: 503-794-0103
  • Fax: 503-794-0104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number556190
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: