MEDICARE: JANINE L DUDLEY OTR 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
1	225X00000X	Occupational Therapist	357475	OR
2	225XH1200X	Hand Occupational Therapist	357475	OR

General Provider Information

NPI Number	:	1598765117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANINE L DUDLEY OTR CHT

Provider Business Mailing Address
First Line	:	25220 S NEWKIRCHNER RD
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-7538
Country	:	US
Telephone Number	:	503-632-8793
Fax Number	:

Provider Business Practice Location Address
First Line	:	19365 SW 65TH AVE
Second Line	:	#200
City	:	TUALATIN
State	:	OR
Zip	:	97062-9196
Country	:	US
Telephone Number	:	503-692-5210
Fax Number	:	503-692-8821

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	05/20/2010

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