Healthcare Provider Details

I. General information

NPI: 1033694674
Provider Name (Legal Business Name): LISA WOODWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2018
Last Update Date: 09/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9135 SW BARNES RD STE 362
PORTLAND OR
97225-6683
US

IV. Provider business mailing address

19860 NW METOLIUS DR
PORTLAND OR
97229-2864
US

V. Phone/Fax

Practice location:
  • Phone: 503-216-2610
  • Fax:
Mailing address:
  • Phone: 503-201-8286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number982232
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: