Basic Information
| Provider Information | |||||||||
| NPI: | 1831612845 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROWELL | ||||||||
| FirstName: | AMY | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1815 SW MARLOW AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972255186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032920765 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1815 SW MARLOW AVE | ||||||||
| Address2: | 110 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032920765 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2017 | ||||||||
| LastUpdateDate: | 08/03/2017 | ||||||||
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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 | 224Z00000X | 2725 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
ID Information
| ID | Type | State | Issuer | Description | 2725 | 01 | OR | OREGON OCCUPATIONAL THERAPY BOARD | OTHER |