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General NPI Number Information
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NPI Number | 1275289241
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Entity Type | Organization
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Legal Business Name | POWER TO THE PELVIS
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 436 SE 12TH AVE
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City | PORTLAND
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State | OR
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Zip | 97214-1323
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Country | US
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Telephone | 503-305-3088
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Fax |
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Provider Business Mailing Address
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Address Line | 436 SE 12TH AVE
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City | PORTLAND
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State | OR
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Zip | 97214-1323
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Country | US
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Telephone | 503-305-3088
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Fax |
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Authorized Official
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Title or Position | DR.
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Name | KIYOKO WILLIAMS
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Credential | OTD
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Telephone | 805-801-1349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number |
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License Number State |
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