Provider Demographics
NPI:1649577487
Name:LUSE, CARRIE AMANDA (MSR, OT/L, ATP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:AMANDA
Last Name:LUSE
Suffix:
Gender:F
Credentials:MSR, OT/L, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 NE 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-5418
Mailing Address - Country:US
Mailing Address - Phone:503-312-3348
Mailing Address - Fax:503-536-6733
Practice Address - Street 1:2100 NE BROADWAY STE 119
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1500
Practice Address - Country:US
Practice Address - Phone:503-312-3348
Practice Address - Fax:503-536-6733
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1053229225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist