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General NPI Number Information
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NPI Number | 1194592907
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Entity Type | Organization
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Legal Business Name | COMMUNITY PEDIATRIC THERAPY LLC
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 16081 SE EIDER CT
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City | DAMASCUS
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State | OR
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Zip | 97089-6809
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Country | US
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Telephone | 503-298-6706
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Fax | 503-272-9393
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Provider Business Mailing Address
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Address Line | 16081 SE EIDER CT
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City | DAMASCUS
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State | OR
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Zip | 97089-6809
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Country | US
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Telephone | 503-298-6706
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Fax | 503-272-9393
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JULIETTE R PIERCE
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Credential | MOT, OTR/L
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Telephone | 503-298-6706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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