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NPI Code Detail

MEDICARE: MAX GIANCARLO COTHREN

MEDICARE: MAX GIANCARLO COTHREN
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
1106S00000XBehavior TechnicianOR

General Provider Information

NPI Number : 1487506002
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAX GIANCARLO COTHREN
Provider Business Mailing Address
First Line : 5457 SW CANYON CT
Second Line :
City : PORTLAND
State : OR
Zip : 97221-2401
Country : US
Telephone Number : 971-762-4663
Fax Number :
Provider Business Practice Location Address
First Line : 5457 SW CANYON CT
Second Line :
City : PORTLAND
State : OR
Zip : 97221-2401
Country : US
Telephone Number : 971-762-4663
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2026
Last Update Date : 02/14/2026

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Directions to “ MAX GIANCARLO COTHREN ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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