Individual
NICOLE RANDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
727 W BURNSIDE ST, PORTLAND, OR 97209-3514
(503) 228-4533
Mailing address
232 NW 6TH AVE, PORTLAND, OR 97209-3609
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
311993
OR
Other
Enumeration date
10/22/2013
Last updated
10/22/2013
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