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General NPI Number Information
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NPI Number | 1801773361
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Entity Type | Individual
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Provider Name | AVERY AARON BROCKBERG OTD, OTR/L
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Gender | Male
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Dates
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Enumeration Date | 08/18/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 8285 SW NIMBUS AVE STE 174
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City | BEAVERTON
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State | OR
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Zip | 97008-6447
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Country | US
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Telephone | 503-579-7327
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Fax |
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Provider Business Mailing Address
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Address Line | 423 NW UPTOWN TER UNIT 2B
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City | PORTLAND
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State | OR
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Zip | 97210-5558
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Country | US
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Telephone | 605-760-1074
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 537257
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License Number State | OR
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