Individual
JESSICA WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5208 NE 122ND AVE, PORTLAND, OR 97230-1074
(503) 351-0902
Mailing address
5208 NE 122ND AVE, PORTLAND, OR 97230-1074
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
1069184
OR
225X00000X
Occupational Therapist
Primary
OC009253
PA
Other
Enumeration date
01/02/2008
Last updated
03/20/2024
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