Individual
MR. JAMISON KEITH CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
9370 SW GREENBURG RD, PORTLAND, OR 97223-5442
(503) 200-5750
Mailing address
11683 SW TEAL BLVD APT M, BEAVERTON, OR 97007-7969
(435) 213-6134
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
447328
OR
225X00000X
Occupational Therapist
OTH-008360
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568052595
—
OR
Enumeration date
01/23/2021
Last updated
02/21/2023
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