MEDICARE: MRS. DEEDRA MARIE WEILL OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	1058877	OR
2	225X00000X	Occupational Therapist	1058877	OR

General Provider Information

NPI Number	:	1053375436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEEDRA MARIE WEILL OTR/L

Provider Business Mailing Address
First Line	:	4739 SW 53RD AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97221-1905
Country	:	US
Telephone Number	:	971-800-0847
Fax Number	:	855-564-1809

Provider Business Practice Location Address
First Line	:	5200 S MACADAM AVE STE 120
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3843
Country	:	US
Telephone Number	:	971-800-0847
Fax Number	:	855-564-1809

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	11/12/2025

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