Provider Demographics
NPI:1013181437
Name:SPORTS & ORTHO REHAB
Entity Type:Organization
Organization Name:SPORTS & ORTHO REHAB
Other - Org Name:HOLY ROSARY HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:541-881-7330
Mailing Address - Street 1:898 SW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914
Mailing Address - Country:US
Mailing Address - Phone:541-881-7330
Mailing Address - Fax:541-881-7334
Practice Address - Street 1:898 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914
Practice Address - Country:US
Practice Address - Phone:541-881-7330
Practice Address - Fax:541-881-7334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT767225X00000X
OR239665225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty