Individual
MARY JO DEVITO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11325 NE WEIDLER ST, PORTLAND, OR 97220-1950
(503) 253-1181
Mailing address
11325 NE WEIDLER ST, PORTLAND, OR 97220-1950
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
428441
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720151988
—
OR
Enumeration date
04/13/2017
Last updated
04/13/2017
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