Healthcare Provider Details

I. General information

NPI: 1396167904
Provider Name (Legal Business Name): MICHELLE VOSSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 WILCO RD
STAYTON OR
97383-1085
US

IV. Provider business mailing address

685 36TH AVE NE
SALEM OR
97301-4741
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-7131
  • Fax: 503-769-7132
Mailing address:
  • Phone: 503-540-8701
  • Fax: 503-371-8772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number312194
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: