Provider Demographics
NPI:1326656695
Name:COUGHLIN, MADELINE HARRIS (OTD)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:HARRIS
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1681 NW CAITLIN TER
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-4697
Mailing Address - Country:US
Mailing Address - Phone:503-709-9498
Mailing Address - Fax:
Practice Address - Street 1:1700 12TH ST STE C
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-9005
Practice Address - Country:US
Practice Address - Phone:541-716-1316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR439252225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist