Individual
TABITA LUCA FOGHIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
812 SE 48TH AVE, PORTLAND, OR 97215-1724
(503) 231-7170
Mailing address
2645 SW WILLOW PKWY, GRESHAM, OR 97080-9563
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
02/23/2021
Last updated
02/23/2021
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