=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669801452
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THERAPEUTIC ASSOCIATES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2013
-----------------------------------------------------
Last Update Date | 05/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 318 NE 99TH ST SUITE B
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98665-5902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-571-2195
-----------------------------------------------------
Fax | 360-571-2408
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16083 SW UPPER BOONES FERRY RD SUITE 300
-----------------------------------------------------
City | TIGARD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97224-7736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-219-8835
-----------------------------------------------------
Fax | 503-639-9699
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | TODD GIFFORD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-219-8835
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------