# CULTIVATE PORTLAND LLP

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

## Provider details

- **NPI number:** 1730409244
- **Authorized official:** BENJAMIN PRAY (PROGRAM MANAGER)
- **Authorized official phone:** (503) 928-8775

## Contact information

- **Practice address:** 2827 NE M L KING JR BLVD, PORTLAND, OR 97212-3039
- **Practice address phone:** (503) 928-8775
- **Practice address fax:** (503) 282-1559
- **Mailing address:** 2827 NE M L KING JR BLVD, PORTLAND, OR 97212-3039

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | 254954 | OR | Yes |
| 225X00000X | Occupational Therapist | 256636 | OR | — |

## Other

- **Enumeration date:** 06/07/2010
- **Last updated:** 06/07/2010