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General NPI Number Information
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NPI Number | 1407520596
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Entity Type | Organization
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Legal Business Name | OUR SPOT FOR KIDS, LLC
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Dates
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Enumeration Date | 08/03/2021
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | 2411 19TH AVE
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City | FOREST GROVE
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State | OR
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Zip | 97116-2895
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Country | US
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Telephone | 321-412-5018
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Fax |
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Provider Business Mailing Address
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Address Line | 2411 19TH AVE
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City | FOREST GROVE
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State | OR
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Zip | 97116-2895
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Country | US
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Telephone | 321-412-5018
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Fax |
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Authorized Official
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Title or Position | OWNER/OCCUPATIONAL THERAPIST
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Name | DR. MANDY BOWDOIN
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Credential | OTD
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Telephone | 321-412-5018
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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 |
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License Number State |
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