Organization
AN INTEGRATED LIFE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIA A SHANNON OTR/L (CEO)
(503) 707-6549
Entity
Organization
Contact information
Practice address
6022 SW KELLY AVE, PORTLAND, OR 97239-3733
(608) 347-0667
Mailing address
4730 SW MACADAM AVE STE 201J, PORTLAND, OR 97239-6417
(503) 707-6549
(503) 974-8543
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1074682
OR
Other
Enumeration date
11/20/2014
Last updated
12/12/2017
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