Healthcare Provider Details

I. General information

NPI: 1902484033
Provider Name (Legal Business Name): OCCUPATIONAL THERAPY CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32080 NW MEADOW DR
NORTH PLAINS OR
97133-2012
US

IV. Provider business mailing address

32080 NW MEADOW DR
NORTH PLAINS OR
97133-2012
US

V. Phone/Fax

Practice location:
  • Phone: 617-957-4902
  • Fax:
Mailing address:
  • Phone: 617-957-4902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE THERESE MARTELL
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 617-957-4902