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Individual

BETTY RIDDLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 215-6059
Mailing address
2623 NE WASCO ST, PORTLAND, OR 97232-1740
(503) 860-3238

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
185710
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
185710
OREGON OT LICENSE
OR
Enumeration date
08/24/2018
Last updated
08/24/2018
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