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NPI Code Detail

MEDICARE: OLIVIA T CRAINE ATRP, PCA

MEDICARE: OLIVIA T CRAINE ATRP, PCA
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
1221700000XArt Therapist25-304OR
2101YM0800XMental Health CounselorR11572OR

General Provider Information

NPI Number : 1255903241
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVIA T CRAINE ATRP, PCA
Provider Business Mailing Address
First Line : 4107 SE GLADSTONE ST APT 1
Second Line :
City : PORTLAND
State : OR
Zip : 97202-3158
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10300 SW EASTRIDGE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97225-5004
Country : US
Telephone Number : 503-944-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2021
Last Update Date : 12/04/2025

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