Basic Information
| Provider Information | |||||||||
| NPI: | 1821305848 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARKER | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | JODEE-GRACE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | MOTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16886 NW PAISLEY DR. | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970064729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415564074 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5711 SW MULTNOMAH BLVD | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972193145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032457621 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2010 | ||||||||
| LastUpdateDate: | 09/13/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | LP 2513 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.