Individual
MADYSON VANOVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1045 SE 149TH PL, PORTLAND, OR 97233-2956
(406) 475-0637
Mailing address
1045 SE 149TH PL, PORTLAND, OR 97233-2956
(406) 475-0637
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
485120
OR
Other
Enumeration date
05/14/2024
Last updated
05/14/2024
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