Individual
TRACY SIMMONS BRUNDAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
707 SW GAINES ST, PORTLAND, OR 97239-2901
(800) 452-3563
Mailing address
2922 SE 54TH AVE, PORTLAND, OR 97206-2142
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1018030
OR
Other
Enumeration date
10/09/2006
Last updated
07/08/2007
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