MEDICARE: CAMILLE GIFFORD 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	225XG0600X	Gerontology Occupational Therapist	1003226	OR
2	225XN1300X	Neurorehabilitation Occupational Therapist	1003226	OR
3	225XP0019X	Physical Rehabilitation Occupational Therapist	1003226	OR

General Provider Information

NPI Number	:	1144667502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE GIFFORD OTR/L

Provider Business Mailing Address
First Line	:	5998 FROST LN
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-4587
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5998 FROST LN
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-4587
Country	:	US
Telephone Number	:	971-270-0621
Fax Number	:

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

Provider Enumeration Date	:	05/25/2013
Last Update Date	:	05/25/2013

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