Healthcare Provider Details

I. General information

NPI: 1003598616
Provider Name (Legal Business Name): RENEE M EINARSON OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E CARPENTER LN
SISTERS OR
97759-9326
US

IV. Provider business mailing address

1019 NW HALE CT
BEND OR
97703-5440
US

V. Phone/Fax

Practice location:
  • Phone: 512-327-4444
  • Fax:
Mailing address:
  • Phone: 541-699-6494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number1058062
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number1058062
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1058062
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: