Provider Demographics
NPI:1376636076
Name:DEHAAN, ALLISON J (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:J
Last Name:DEHAAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:VAN EERDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:13270 NW PETTYGROVE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-4546
Mailing Address - Country:US
Mailing Address - Phone:971-275-7278
Mailing Address - Fax:971-206-5209
Practice Address - Street 1:CONSONUS REHAB SERVICES
Practice Address - Street 2:4560 SE INTERNATIONAL WAY
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222
Practice Address - Country:US
Practice Address - Phone:971-206-5140
Practice Address - Fax:971-206-5209
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1072670225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR234430OtherOMAP