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General NPI Number Information
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NPI Number | 1043601602
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Entity Type | Organization
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Legal Business Name | INFINITY REHAB
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Dates
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Enumeration Date | 02/17/2015
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Last Update Date | 02/17/2015
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Provider Practice Location Address
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Address Line | 8750 SE 155TH AVE 18
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-5533
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Country | US
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Telephone | 503-267-1610
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Fax |
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Provider Business Mailing Address
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Address Line | 8750 SE 155TH AVE 18
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-5533
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Country | US
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Telephone | 503-267-1610
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Fax |
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Authorized Official
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Title or Position | COTA
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Name | ROWENA J WIER
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Credential |
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Telephone | 503-267-1610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 408047
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License Number State | OR
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