Healthcare Provider Details

I. General information

NPI: 1710607585
Provider Name (Legal Business Name): DAFNA SHARON NOAM OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAFNI NOAM

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24076 SE STARK ST STE 200
GRESHAM OR
97030-3376
US

IV. Provider business mailing address

24076 SE STARK ST STE 200
GRESHAM OR
97030-3376
US

V. Phone/Fax

Practice location:
  • Phone: 503-674-7860
  • Fax: 503-674-7642
Mailing address:
  • Phone: 503-674-7860
  • Fax: 503-674-7642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number324932
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: