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Individual

PETER VAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
10123 SE MARKET ST, PORTLAND, OR 97216-2532
(503) 257-2500
Mailing address
1481 NW 13TH AVE APT 112, PORTLAND, OR 97209-3405
(303) 618-0306

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
533158
OR
390200000X
Student in an Organized Health Care Education/Training Program
Primary

Other

Enumeration date
08/07/2024
Last updated
04/21/2026
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