Provider Demographics
NPI:1417275066
Name:EBERT, GINGER ELIZABETH (MOTR/L)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:ELIZABETH
Last Name:EBERT
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:ELIZABETH
Other - Last Name:HOOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3030 NE 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3030 NE 31ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3658
Practice Address - Country:US
Practice Address - Phone:503-449-3656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR234790225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist