Provider Demographics
NPI:1275289241
Name:POWER TO THE PELVIS
Entity Type:Organization
Organization Name:POWER TO THE PELVIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:KIYOKO
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OTD
Authorized Official - Phone:805-801-1349
Mailing Address - Street 1:436 SE 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1323
Mailing Address - Country:US
Mailing Address - Phone:503-305-3088
Mailing Address - Fax:
Practice Address - Street 1:436 SE 12TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1323
Practice Address - Country:US
Practice Address - Phone:503-305-3088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR367851OtherOCCUPATIONAL THERAPIST LICENSE
CA23171OtherOCCUPATIONAL THERAPIST LICENSE