Healthcare Provider Details

I. General information

NPI: 1821843434
Provider Name (Legal Business Name): ENTHUSIASTIC PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81830 MINNOW CREEK RD
LOWELL OR
97452-9741
US

IV. Provider business mailing address

81830 MINNOW CREEK RD
LOWELL OR
97452-9741
US

V. Phone/Fax

Practice location:
  • Phone: 541-449-7251
  • Fax: 541-543-2263
Mailing address:
  • Phone: 541-449-7251
  • Fax: 541-543-2263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ERIN OELKLAUS
Title or Position: OWNER/CEO
Credential:
Phone: 541-449-7251