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NPI Code Detail

MEDICARE: MS. LORI LEE LINGLE ELLING OTL CHT

MEDICARE: MS. LORI LEE LINGLE ELLING OTL CHT
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
1225X00000XOccupational Therapist000373OR

General Provider Information

NPI Number : 1194858944
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LORI LEE LINGLE ELLING OTL CHT
Provider Business Mailing Address
First Line : PO BOX 3158
Second Line :
City : PORTLAND
State : OR
Zip : 97208-3158
Country : US
Telephone Number : 503-215-6494
Fax Number :
Provider Business Practice Location Address
First Line : 12345 SW HORIZON BLVD STE 57
Second Line :
City : BEAVERTON
State : OR
Zip : 97007-9475
Country : US
Telephone Number : 503-216-8825
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2007
Last Update Date : 09/11/2020

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