Individual
RUSS HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 215-5289
Mailing address
8534 SE 32ND AVE, MILWAUKIE, OR 97222-5504
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1011449
OR
Other
Enumeration date
05/23/2007
Last updated
07/08/2007
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