Healthcare Provider Details

I. General information

NPI: 1659046506
Provider Name (Legal Business Name): ELIZABETH YAY-GERWIG OTR/L, OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19250 SW 65TH AVE STE 125
TUALATIN OR
97062-7745
US

IV. Provider business mailing address

PO BOX 6689
PORTLAND OR
97228-6689
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-4505
  • Fax:
Mailing address:
  • Phone: 503-413-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number431043
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number20888
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: