Provider Demographics
NPI:1538499215
Name:HAND AND ARM THERAPY OF CENTRAL OREGON INC
Entity Type:Organization
Organization Name:HAND AND ARM THERAPY OF CENTRAL OREGON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GULICK
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CHT
Authorized Official - Phone:541-633-7535
Mailing Address - Street 1:PO BOX 7377
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-7377
Mailing Address - Country:US
Mailing Address - Phone:541-633-7535
Mailing Address - Fax:541-706-9036
Practice Address - Street 1:2100 NE NEFF RD
Practice Address - Street 2:SUITE A
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6213
Practice Address - Country:US
Practice Address - Phone:541-633-7535
Practice Address - Fax:541-706-9036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-02
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR914195225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500617805Medicaid
OR500617805Medicaid
ORR152233Medicare PIN