Provider Demographics
NPI:1407305501
Name:HORSES ADAPTIVE RIDING AND THERAPY
Entity Type:Organization
Organization Name:HORSES ADAPTIVE RIDING AND THERAPY
Other - Org Name:HART
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WAINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-510-7643
Mailing Address - Street 1:6665 RICKREALL RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97351-9630
Mailing Address - Country:US
Mailing Address - Phone:971-301-4278
Mailing Address - Fax:
Practice Address - Street 1:6665 RICKREALL RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OR
Practice Address - Zip Code:97351-9630
Practice Address - Country:US
Practice Address - Phone:971-301-4278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA5573106H00000X
OR1050605225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500615564Medicaid