Provider Demographics
NPI:1316542608
Name:RESNICK, HAYDEN (OTD OTR/L)
Entity Type:Individual
Prefix:
First Name:HAYDEN
Middle Name:
Last Name:RESNICK
Suffix:
Gender:F
Credentials:OTD OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17601 S DICK DR
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-9207
Mailing Address - Country:US
Mailing Address - Phone:503-593-8654
Mailing Address - Fax:
Practice Address - Street 1:17601 S DICK DR
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-9207
Practice Address - Country:US
Practice Address - Phone:503-593-8654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR445157225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR445157OtherSTATE OF OREGON