Provider Demographics
NPI:1033681762
Name:CASTELLANOS, MALEA LYNN (OTD, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MALEA
Middle Name:LYNN
Last Name:CASTELLANOS
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8339 SW BEAVERTON HILLSDALE HWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-2215
Mailing Address - Country:US
Mailing Address - Phone:503-245-5639
Mailing Address - Fax:503-245-6013
Practice Address - Street 1:8339 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-2215
Practice Address - Country:US
Practice Address - Phone:503-245-5639
Practice Address - Fax:503-245-6013
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR410169225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist