Basic Information
| Provider Information | |||||||||
| NPI: | 1831222108 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITT | ||||||||
| FirstName: | MICHELLE | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | OREGON CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970452241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036578903 | ||||||||
| FaxNumber: | 5036504302 | ||||||||
| Practice Location | |||||||||
| Address1: | 610 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | OREGON CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970452241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036578903 | ||||||||
| FaxNumber: | 5036504302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 03/06/2015 | ||||||||
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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 | 271 | NM | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 558346 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 500682447 | 05 | OR | MEDICAID | Z 999 | 05 | NM | MEDICAID |