Healthcare Provider Details

I. General information

NPI: 1669799433
Provider Name (Legal Business Name): ALISON ELSBERRY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 SW 17TH ST SUITE# 202
REDMOND OR
97756-2572
US

IV. Provider business mailing address

916 SW 17TH ST SUITE# 202
REDMOND OR
97756-2572
US

V. Phone/Fax

Practice location:
  • Phone: 541-504-0250
  • Fax:
Mailing address:
  • Phone: 208-507-0199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1040682
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: