Provider Demographics
NPI:1598765117
Name:DUDLEY, JANINE L (OTR CHT)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:L
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:OTR CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25220 S NEWKIRCHNER RD
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-7538
Mailing Address - Country:US
Mailing Address - Phone:503-632-8793
Mailing Address - Fax:
Practice Address - Street 1:19365 SW 65TH AVE
Practice Address - Street 2:#200
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9196
Practice Address - Country:US
Practice Address - Phone:503-692-5210
Practice Address - Fax:503-692-8821
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR357475225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR110498Medicare ID - Type Unspecified