Basic Information
| Provider Information | |||||||||
| NPI: | 1811209653 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CODINA | ||||||||
| FirstName: | BRYAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4062 ARLETA AVE NE | ||||||||
| Address2: | |||||||||
| City: | KEIZER | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973034758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033902271 | ||||||||
| FaxNumber: | 5033900177 | ||||||||
| Practice Location | |||||||||
| Address1: | 4062 ARLETA AVE NE | ||||||||
| Address2: | |||||||||
| City: | KEIZER | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973034758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033902271 | ||||||||
| FaxNumber: | 5033900177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2010 | ||||||||
| LastUpdateDate: | 07/09/2010 | ||||||||
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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 | 1066053 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.