Provider Demographics
NPI:1003942293
Name:ENGLISH, JUDITH LESLIE (OTR)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:LESLIE
Last Name:ENGLISH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:LESLIE
Other - Last Name:HOPKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:815 NW JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-9731
Mailing Address - Country:US
Mailing Address - Phone:541-754-8090
Mailing Address - Fax:
Practice Address - Street 1:111 N 20TH ST
Practice Address - Street 2:
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370-9621
Practice Address - Country:US
Practice Address - Phone:541-368-4313
Practice Address - Fax:541-929-4967
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR153888174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR15388OtherSTATE LICENSE