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NPI Code Detail

MEDICARE: NANCY L GROSSENBACHER OTR

MEDICARE: NANCY L GROSSENBACHER OTR
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
1225XH1200XHand Occupational Therapist282681OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20040494OTHERWAWA L&I
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538142278
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY L GROSSENBACHER OTR
Provider Business Mailing Address
First Line : 2330 NW FLANDERS ST
Second Line : STE G-1
City : PORTLAND
State : OR
Zip : 97210-3442
Country : US
Telephone Number : 503-224-9270
Fax Number : 503-224-9271
Provider Business Practice Location Address
First Line : 2330 NW FLANDERS ST
Second Line : STE G-1
City : PORTLAND
State : OR
Zip : 97210-3442
Country : US
Telephone Number : 503-224-9270
Fax Number : 503-224-9271
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2005
Last Update Date : 07/09/2007

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1164405742 — KATHERINE A STEVENS OTR
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1821073925 — ALEXANDRA M MACKENZIE OTR/L, CHT
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1811972912 — JEANINE K WARD OTR/L
Practice Location Address:
2330 NW FLANDERS ST , STE G-1
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Practice Fax: 503-224-9271

Directions to “ NANCY L GROSSENBACHER OTR” Practice Location

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