Provider Demographics
NPI:1225190994
Name:HANDS ON UPPER EXTREMITY REHAB LLC
Entity Type:Organization
Organization Name:HANDS ON UPPER EXTREMITY REHAB LLC
Other - Org Name:HANDS ON UPPER EXTREMITY REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:JOHANNA
Authorized Official - Last Name:LIEPELT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR,CHT
Authorized Official - Phone:503-229-8300
Mailing Address - Street 1:PO BOX 82564
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97282-0564
Mailing Address - Country:US
Mailing Address - Phone:503-229-8300
Mailing Address - Fax:
Practice Address - Street 1:17020 SW UPPER BOONES FERRY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-7078
Practice Address - Country:US
Practice Address - Phone:503-229-8300
Practice Address - Fax:503-229-8301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR969795225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5846140001Medicare NSC