Provider Demographics
NPI:1093298705
Name:BANIQUED, NATHANIEL NAZARENO (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:NAZARENO
Last Name:BANIQUED
Suffix:
Gender:M
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 1:5825 NE RAY CIR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6436
Mailing Address - Country:US
Mailing Address - Phone:503-614-1428
Mailing Address - Fax:
Practice Address - Street 1:5825 NE RAY CIR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6436
Practice Address - Country:US
Practice Address - Phone:503-614-1428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR502920225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist