Individual
TYLER ICHIKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
24076 SE STARK ST STE 210, GRESHAM, OR 97030-3376
(503) 491-1666
Mailing address
24076 SE STARK ST STE 210, GRESHAM, OR 97030-3376
(503) 491-1666
Taxonomy
Speciality
Code
Description
License number
State
225XH1200X
Hand Occupational Therapist
Primary
505784
OR
Other
Enumeration date
10/08/2024
Last updated
10/08/2024
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