Individual
DIEDRA M PINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT
Contact information
Practice address
1675 SW MARLOW AVE STE 200, PORTLAND, OR 97225-5102
(503) 802-5261
(503) 905-6159
Mailing address
4548 NE HOLMAN ST, PORTLAND, OR 97218-1349
(503) 289-5901
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
01060048
OR
Other
Enumeration date
04/03/2007
Last updated
07/08/2007
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