Healthcare Provider Details

I. General information

NPI: 1053445874
Provider Name (Legal Business Name): VICTORIA M HORTON OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 SE POWELL VALLEY RD
GRESHAM OR
97080-1919
US

IV. Provider business mailing address

3354 SE 177TH AVE
PORTLAND OR
97236-1137
US

V. Phone/Fax

Practice location:
  • Phone: 503-665-1151
  • Fax:
Mailing address:
  • Phone: 503-760-5476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1022153
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: