Healthcare Provider Details

I. General information

NPI: 1093023178
Provider Name (Legal Business Name): RACHEL CITRON O'ROURKE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 SW OAK ST SUITE 520
PORTLAND OR
97204-1817
US

IV. Provider business mailing address

421 SW OAK ST SUITE 520
PORTLAND OR
97204-1817
US

V. Phone/Fax

Practice location:
  • Phone: 503-988-5464
  • Fax:
Mailing address:
  • Phone: 503-988-5464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: