Healthcare Provider Details

I. General information

NPI: 1073441390
Provider Name (Legal Business Name): MEAZA ZELEKE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 NE ROBERTS AVE
GRESHAM OR
97030-2769
US

IV. Provider business mailing address

10602 SE MIRANDOL ST
HAPPY VALLEY OR
97086-6991
US

V. Phone/Fax

Practice location:
  • Phone: 240-481-4270
  • Fax:
Mailing address:
  • Phone: 240-481-4270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License NumberNA
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: