# WHOLE CIRCLE PEDIATRIC THERAPY, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649882549
- **Authorized official:** DIEDRA MARIE PINE OTR/L (OWNER/OCCUPATIONAL THERAPIST)
- **Authorized official phone:** (503) 997-1309

## Contact information

- **Practice address:** 8028 E BURNSIDE ST, PORTLAND, OR 97215-1549
- **Practice address phone:** (503) 502-7515
- **Practice address fax:** (971) 382-5222
- **Mailing address:** 8028 E BURNSIDE ST, PORTLAND, OR 97215-1549
- **Mailing address phone:** (503) 502-7515
- **Mailing address fax:** (971) 382-5222

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225XP0200X | Pediatric Occupational Therapist | — | NULL | — |
| 225XP0200X | Pediatric Occupational Therapist | — | — | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/20/2020
- **Last updated:** 06/02/2022