Provider Demographics
NPI:1194359315
Name:SORENSEN, TERESA (OTD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:TESS
Other - Middle Name:
Other - Last Name:SORENSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTD
Mailing Address - Street 1:8825 N FISKE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-3536
Mailing Address - Country:US
Mailing Address - Phone:503-928-2325
Mailing Address - Fax:
Practice Address - Street 1:5330 NE PRESCOTT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-2158
Practice Address - Country:US
Practice Address - Phone:503-288-6585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR430561225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation