Basic Information
| Provider Information | |||||||||
| NPI: | 1760955009 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OSBORN | ||||||||
| FirstName: | ALAINA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7204 SW DURHAM RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972247574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032920765 | ||||||||
| FaxNumber: | 5032925208 | ||||||||
| Practice Location | |||||||||
| Address1: | 1815 SW MARLOW AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972255186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032920765 | ||||||||
| FaxNumber: | 5032925208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2019 | ||||||||
| LastUpdateDate: | 09/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 338617 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | NA | 01 | NA/PENDING | OTHER |