Individual
CAROLYN CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT/L
Contact information
Practice address
6635 N BALTIMORE AVE, SUITE 228, PORTLAND, OR 97203-5454
(503) 477-9527
(503) 477-9529
Mailing address
6635 N BALTIMORE AVE, SUITE 228, PORTLAND, OR 97203-5454
(503) 477-9527
(503) 477-9529
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
985071
OR
Other
Enumeration date
09/03/2009
Last updated
05/08/2013
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