Provider Demographics
NPI:1205007689
Name:CABRERA, TRICIA MICHELLE (OTRL)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:MICHELLE
Last Name:CABRERA
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 SE INTERNATIONAL WAY SUITE 100
Mailing Address - Street 2:CONSONUS REHAB SERVICES
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222
Mailing Address - Country:US
Mailing Address - Phone:971-206-5149
Mailing Address - Fax:971-206-5209
Practice Address - Street 1:646 16TH ST
Practice Address - Street 2:CLATSOP CARE CENTER
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3709
Practice Address - Country:US
Practice Address - Phone:503-325-0313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2014-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9882225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist