Healthcare Provider Details

I. General information

NPI: 1083502579
Provider Name (Legal Business Name): SIEGFRIED OCKER DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 NW 4TH ST APT B
REDMOND OR
97756-1328
US

IV. Provider business mailing address

805 SW INDUSTRIAL WAY STE 3
BEND OR
97702-1093
US

V. Phone/Fax

Practice location:
  • Phone: 541-504-2350
  • Fax: 541-504-2354
Mailing address:
  • Phone: 541-504-2350
  • Fax: 541-504-2354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number65768
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: