MEDICARE: SUZAN JAN LINEHAN BS

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	2177	MA

General Provider Information

NPI Number	:	1891214854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZAN JAN LINEHAN BS

Provider Business Mailing Address
First Line	:	7320 SW HUNZIKER ST STE 203
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-2301
Country	:	US
Telephone Number	:	971-770-0404
Fax Number	:	503-874-6516

Provider Business Practice Location Address
First Line	:	29700 SW MOUNTAIN RD
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-9649
Country	:	US
Telephone Number	:	508-728-2432
Fax Number	:

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

Provider Enumeration Date	:	09/11/2017
Last Update Date	:	09/11/2017

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