Basic Information
| Provider Information | |||||||||
| NPI: | 1043688203 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | OOLEY | ||||||||
| FirstName: | DUSTIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 707 SW GAINES ST | ||||||||
| Address2: | CHILD DEVELOPMENT AND REHAB CTR | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972392901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034948311 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12780 SW CAMELIA ST | ||||||||
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| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970050753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712757840 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2015 | ||||||||
| LastUpdateDate: | 10/21/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 30833 | OR | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.