Basic Information
Provider Information | |||||||||
NPI: | 1073833109 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CALIFF | ||||||||
FirstName: | BRITTANY | ||||||||
MiddleName: | D. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MOT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HEFNER | ||||||||
OtherFirstName: | BRITTANY | ||||||||
OtherMiddleName: | D | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MOT | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 610 HIGH ST | ||||||||
Address2: |   | ||||||||
City: | OREGON CITY | ||||||||
State: | OR | ||||||||
PostalCode: | 970452241 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5036578903 | ||||||||
FaxNumber: | 5036504302 | ||||||||
Practice Location | |||||||||
Address1: | 610 HIGH ST | ||||||||
Address2: |   | ||||||||
City: | OREGON CITY | ||||||||
State: | OR | ||||||||
PostalCode: | 970452241 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5036578903 | ||||||||
FaxNumber: | 5036504302 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/11/2010 | ||||||||
LastUpdateDate: | 05/14/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 269235 | OR | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 500623779 | 05 | OR |   | MEDICAID | 2007574 | 05 | WA |   | MEDICAID |