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General NPI Number Information
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NPI Number | 1912329459
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Entity Type | Organization
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Legal Business Name | COOPERATIVE THERAPIES NW
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Dates
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Enumeration Date | 01/17/2014
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Last Update Date | 01/17/2014
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Provider Practice Location Address
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Address Line | 7759 SW CIRRUS DR
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City | BEAVERTON
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State | OR
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Zip | 97008-5968
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Country | US
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Telephone | 503-433-8085
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Fax |
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Provider Business Mailing Address
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Address Line | 7759 SW CIRRUS DR
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City | BEAVERTON
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State | OR
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Zip | 97008-5968
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Country | US
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Telephone | 503-433-8085
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Fax |
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Authorized Official
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Title or Position | CLINIC ASSISTANT AND CREDENTIALING
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Name | SOPHIE HART
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Credential |
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Telephone | 503-433-8085
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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 | 233731
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 13513
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License Number State | OR
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