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Individual

NICOLE RENEE WANDELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
4805 NE GLISAN ST, OCCUPATIONAL THERAPY, PORTLAND, OR 97213-2933
(150) 321-5650
(503) 215-6500
Mailing address
PO BOX 19811, PORTLAND, OR 97280-0811

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
296700
OR

Other

Enumeration date
12/15/2012
Last updated
12/15/2012
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