Organization
SUPPLEMENTAL HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEVYN HALL (COTA)
(520) 975-7573
Entity
Organization
Contact information
Practice address
7320 SW HUNZIKER ST STE 203, TIGARD, OR 97223-2301
(888) 317-1019
Mailing address
7320 SW HUNZIKER, SUITE 203, TIGARD, OR 97223-2301
(888) 317-1019
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
314621
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
314621
—
OR
Enumeration date
08/26/2014
Last updated
08/26/2014
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