Healthcare Provider Details

I. General information

NPI: 1730531724
Provider Name (Legal Business Name): MASON MUNSON OTD, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MEREDITH MUNSON

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 SE 182ND AVE
GRESHAM OR
97030-5036
US

IV. Provider business mailing address

25117 SW PARKWAY AVE STE D
WILSONVILLE OR
97070-9697
US

V. Phone/Fax

Practice location:
  • Phone: 503-665-0183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number348759
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: