Individual
MRS. AUTUMN JESSICA CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
2701 NW VAUGHN ST, PORTLAND, OR 97210-5311
(503) 721-6800
Mailing address
2114 N SUMNER ST, PORTLAND, OR 97217-3831
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1034600
OR
225X00000X
Occupational Therapist
OT00004159
WA
Other
Enumeration date
09/20/2006
Last updated
07/15/2010
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