Provider Demographics
NPI:1659978302
Name:ATENCIO, ANDREA MARIA (COTA/L)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIA
Last Name:ATENCIO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MARIA
Other - Last Name:BINOEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:763 SE HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4562
Mailing Address - Country:US
Mailing Address - Phone:503-984-6967
Mailing Address - Fax:
Practice Address - Street 1:4560 SE INTERNATIONAL WAY STE 100
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-4628
Practice Address - Country:US
Practice Address - Phone:971-206-5202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1016613224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant