Provider Demographics
NPI:1407331762
Name:MCDONALD, KAYLEY IRENE (OTD, OTR)
Entity Type:Individual
Prefix:
First Name:KAYLEY
Middle Name:IRENE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 NW 169TH PL STE 3070
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7368
Mailing Address - Country:US
Mailing Address - Phone:971-249-2653
Mailing Address - Fax:503-747-4373
Practice Address - Street 1:1815 NW 169TH PL STE 3070
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7368
Practice Address - Country:US
Practice Address - Phone:971-249-2653
Practice Address - Fax:503-747-4373
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR409062225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics