Provider Demographics
NPI:1043418585
Name:MAHAPATRA, ARUNDHATI (BOT,DROT)
Entity Type:Individual
Prefix:MRS
First Name:ARUNDHATI
Middle Name:
Last Name:MAHAPATRA
Suffix:
Gender:F
Credentials:BOT,DROT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13180 NW HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-3759
Mailing Address - Country:US
Mailing Address - Phone:503-629-9868
Mailing Address - Fax:
Practice Address - Street 1:5701 SW MULTNOMAH BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3195
Practice Address - Country:US
Practice Address - Phone:503-244-1107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1043570225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR275094Medicaid
OR1043570OtherOT STATE LICENSE