Healthcare Provider Details

I. General information

NPI: 1669844171
Provider Name (Legal Business Name): MCKENZIE HULL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19250 SW 65TH AVE STE 125
TUALATIN OR
97062
US

IV. Provider business mailing address

1650 NW NAITO PKWY STE 185
PORTLAND OR
97209-2535
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-4505
  • Fax: 503-413-4719
Mailing address:
  • Phone: 971-983-5260
  • Fax: 971-983-5326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056011253
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number349715
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: