Provider Demographics
NPI:1114362712
Name:MUD SPOONS & SWINGS LLC
Entity Type:Organization
Organization Name:MUD SPOONS & SWINGS LLC
Other - Org Name:DANA YANOCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:YANOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR/L
Authorized Official - Phone:503-349-9007
Mailing Address - Street 1:2818 SE 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-1856
Mailing Address - Country:US
Mailing Address - Phone:503-349-9007
Mailing Address - Fax:877-239-8868
Practice Address - Street 1:2818 SE 75TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-1856
Practice Address - Country:US
Practice Address - Phone:503-349-9007
Practice Address - Fax:877-239-8868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1054075225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1962747352OtherNPI OF OTR