Provider Demographics
NPI:1659987147
Name:KUEHL, DESTINY TAMA-MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:TAMA-MARIE
Last Name:KUEHL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:DESTINY
Other - Middle Name:
Other - Last Name:KUEHL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:13206 SE RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-3944
Mailing Address - Country:US
Mailing Address - Phone:503-729-7869
Mailing Address - Fax:
Practice Address - Street 1:5220 NE SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2666
Practice Address - Country:US
Practice Address - Phone:503-729-7869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-20
Last Update Date:2020-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR440858225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist