Individual
FAYE A WHITACRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
3060 SE STARK ST, PORTLAND, OR 97214-3053
(503) 535-4700
Mailing address
3060 SE STARK ST, PORTLAND, OR 97214-3053
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
993950
OR
Other
Enumeration date
09/13/2013
Last updated
09/13/2013
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