Healthcare Provider Details

I. General information

NPI: 1487109039
Provider Name (Legal Business Name): SARAH ELIZABETH BOCCHICCHIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5289 NE ELAM YOUNG PKWY STE 140
HILLSBORO OR
97124-7551
US

IV. Provider business mailing address

113 N ELM ST
CANBY OR
97013-3519
US

V. Phone/Fax

Practice location:
  • Phone: 503-747-5359
  • Fax:
Mailing address:
  • Phone: 503-263-8903
  • Fax: 503-266-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number452360
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: