Individual
LISA MARY PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
5232 N INTERSTATE AVE, PORTLAND, OR 97217-4023
(503) 449-0788
Mailing address
5232 N INTERSTATE AVE, PORTLAND, OR 97217-3767
(503) 575-9402
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
995621
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
231888
—
OR
Enumeration date
03/18/2006
Last updated
08/26/2011
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