Basic Information
| Provider Information | |||||||||
| NPI: | 1366675720 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARPENTER | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | RAYMOND | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1815 SW MARLOW AVE | ||||||||
| Address2: | STE 110 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972255185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032920765 | ||||||||
| FaxNumber: | 5032925208 | ||||||||
| Practice Location | |||||||||
| Address1: | 1815 SW MARLOW AVE | ||||||||
| Address2: | STE 110 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972255185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032920765 | ||||||||
| FaxNumber: | 5032925208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2009 | ||||||||
| LastUpdateDate: | 09/01/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 256636 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.