Healthcare Provider Details

I. General information

NPI: 1639912942
Provider Name (Legal Business Name): CATHY ARLENE SANDERS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 07/13/2024
Certification Date: 07/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 SW MARIETTA LN
DALLAS OR
97338-1215
US

IV. Provider business mailing address

1131 SW MARIETTA LN
DALLAS OR
97338-1215
US

V. Phone/Fax

Practice location:
  • Phone: 503-881-1642
  • Fax:
Mailing address:
  • Phone: 503-881-1642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number597503
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: