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NPI Code Detail

MEDICARE: FAYE A WHITACRE O.T.

MEDICARE: FAYE A WHITACRE O.T.
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 Therapist993950OR

General Provider Information

NPI Number : 1770918310
Entity Type Code : Individual
Provider Name (Legal Business Name) : FAYE A WHITACRE O.T.
Provider Business Mailing Address
First Line : 3060 SE STARK ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-3053
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3060 SE STARK ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-3053
Country : US
Telephone Number : 503-535-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2013
Last Update Date : 09/13/2013

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Directions to “ FAYE A WHITACRE O.T.” Practice Location

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