Individual
MAYANNA LYNNE DETTWYLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
10330 SE 32ND AVE, MILWAUKIE, OR 97222-6587
(503) 513-8600
Mailing address
1212 SE OAK GROVE BLVD, MILWAUKIE, OR 97267-1073
(503) 580-8081
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
406400
OR
Other
Enumeration date
08/19/2018
Last updated
08/19/2018
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