Provider Demographics
NPI:1255865663
Name:FORWARD STRIDE
Entity Type:Organization
Organization Name:FORWARD STRIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERY
Authorized Official - Middle Name:BRISBANE
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:503-737-5380
Mailing Address - Street 1:18218 SW HORSE TALE DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-9789
Mailing Address - Country:US
Mailing Address - Phone:503-590-2959
Mailing Address - Fax:
Practice Address - Street 1:18218 SW HORSE TALE DR
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-9789
Practice Address - Country:US
Practice Address - Phone:503-590-2959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2872261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation