Healthcare Provider Details

I. General information

NPI: 1174672828
Provider Name (Legal Business Name): BARRY GOWAN KNOX JR. CERTIFIED OCCUPATION
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BARRY GOWAN KNOX JR. COTA

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4560 SE INTERNATIONAL WAY CONSONUS REHAB SERVICES
MILWAUKIE OR
97222
US

IV. Provider business mailing address

4560 SE INTERNATIONAL WAY
MILWAUKIE OR
97222
US

V. Phone/Fax

Practice location:
  • Phone: 971-206-5140
  • Fax: 971-206-5209
Mailing address:
  • Phone: 971-206-5140
  • Fax: 971-206-5209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number209371
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: