Individual
MS. SAGE MAETTA FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT OTRL
Contact information
Practice address
610 HIGH STREET, OREGON CITY, OR 97045
(503) 657-8903
(503) 650-4302
Mailing address
PO BOX 1122, 610 HIGH STREET, OREGON CITY, OR 97045
(503) 657-8903
(503) 650-4302
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
231089
—
OR
05
—
8397929
—
WA
Enumeration date
01/09/2007
Last updated
07/08/2007
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