Organization
CULTIVATE PORTLAND LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN PRAY (PROGRAM MANAGER)
(503) 928-8775
Entity
Organization
Contact information
Practice address
2827 NE M L KING JR BLVD, PORTLAND, OR 97212-3039
(503) 928-8775
(503) 282-1559
Mailing address
2827 NE M L KING JR BLVD, PORTLAND, OR 97212-3039
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
254954
OR
225X00000X
Occupational Therapist
256636
OR
Other
Enumeration date
06/07/2010
Last updated
06/07/2010
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