Healthcare Provider Details

I. General information

NPI: 1942520556
Provider Name (Legal Business Name): WILLAMETTE HAND THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 WILLAMETTE ST SUITE 302
EUGENE OR
97401-4014
US

IV. Provider business mailing address

1711 WILLAMETTE ST SUITE 302
EUGENE OR
97401-4014
US

V. Phone/Fax

Practice location:
  • Phone: 541-357-4536
  • Fax: 541-659-9669
Mailing address:
  • Phone: 541-357-4536
  • Fax: 541-653-9669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. DEBBIE MARIE AHEARN
Title or Position: OWNER
Credential: MA, OTR/L, CHT
Phone: 541-359-4536