Healthcare Provider Details

I. General information

NPI: 1386793347
Provider Name (Legal Business Name): DEBORAH LEE FERGUSON OTR/L LICENSED OCCUP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8050 SW WARM SPRINGS RD SUITE 130
TUALATIN OR
97062
US

IV. Provider business mailing address

8050 SW WARM SPRINGS RD SUITE 130
TUALATIN OR
97062
US

V. Phone/Fax

Practice location:
  • Phone: 503-564-0565
  • Fax: 503-563-5281
Mailing address:
  • Phone: 503-564-0565
  • Fax: 503-563-5281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number606012
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: