Basic Information
| Provider Information | |||||||||
| NPI: | 1821478843 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ANDERSON | ||||||||
| FirstName: | AUSTIN | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25117 SW PARKWAY AVE STE D | ||||||||
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| City: | WILSONVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970709697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037832482 | ||||||||
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| Practice Location | |||||||||
| Address1: | 308 W EMMA ST | ||||||||
| Address2: | |||||||||
| City: | UNION GAP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989031940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092481985 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2015 | ||||||||
| LastUpdateDate: | 06/04/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OC60558654 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.