Provider Demographics
NPI:1114218526
Name:COUGHLIN, CYNTHIA HARRIS (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:HARRIS
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1681 NW CAITLIN TER
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-4697
Mailing Address - Country:US
Mailing Address - Phone:503-643-1372
Mailing Address - Fax:
Practice Address - Street 1:11850 SW ALLEN BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4805
Practice Address - Country:US
Practice Address - Phone:503-646-7164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR969434225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist