Organization
PEDIATRIC OCCUPATIONAL THERAPY SOLUTIONS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIEDRA MARIE PINE OTL (OCCUPATIONAL THERAPIST/OWNER)
(503) 997-1309
Entity
Organization
Contact information
Practice address
5220 NE SACRAMENTO ST, PORTLAND, OR 97213-2666
(503) 997-1309
(971) 888-5266
Mailing address
4548 NE HOLMAN ST, PORTLAND, OR 97218-1349
(503) 997-1309
(971) 888-5266
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500189782
—
OR
Enumeration date
04/23/2019
Last updated
04/23/2019
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