Healthcare Provider Details

I. General information

NPI: 1235509647
Provider Name (Legal Business Name): NICHOLAS HORTON OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2015
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 NE SCHUYLER ST
PORTLAND OR
97212-3924
US

IV. Provider business mailing address

737 NE SCHUYLER ST
PORTLAND OR
97212-3924
US

V. Phone/Fax

Practice location:
  • Phone: 918-565-0059
  • Fax:
Mailing address:
  • Phone: 918-565-0059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number328753
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 60490276
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: