Provider Demographics
NPI:1497179907
Name:UNDSETH, PAIGE EMILY (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:EMILY
Last Name:UNDSETH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:EMILY
Other - Last Name:HOLTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4560 SE INTERNATIONAL WAY
Mailing Address - Street 2:STE. 100
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222
Mailing Address - Country:US
Mailing Address - Phone:971-206-5200
Mailing Address - Fax:971-206-5203
Practice Address - Street 1:3959 SHERIDAN AVE.
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459
Practice Address - Country:US
Practice Address - Phone:541-756-4151
Practice Address - Fax:541-751-7715
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR312468224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant