Healthcare Provider Details

I. General information

NPI: 1346790268
Provider Name (Legal Business Name): INGRID BORLAND OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 NE RUSSELL ST
PORTLAND OR
97212-3827
US

IV. Provider business mailing address

519 NE RUSSELL ST
PORTLAND OR
97212-3827
US

V. Phone/Fax

Practice location:
  • Phone: 971-808-3255
  • Fax:
Mailing address:
  • Phone: 971-808-3255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number309530
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number309530
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: