Healthcare Provider Details

I. General information

NPI: 1265823298
Provider Name (Legal Business Name): LAURA CATHERINE ANDERSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 SE 100TH AVENUE
PORTLAND OR
97216
US

IV. Provider business mailing address

3423 SE MADISON ST
PORTLAND OR
97214-4252
US

V. Phone/Fax

Practice location:
  • Phone: 503-262-6000
  • Fax:
Mailing address:
  • Phone: 503-505-8586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number335708
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: