Provider Demographics
NPI:1679094247
Name:ESPIRITU, EDELINA LANZON (COTA)
Entity Type:Individual
Prefix:
First Name:EDELINA
Middle Name:LANZON
Last Name:ESPIRITU
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1577 S IVY ST
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-4334
Mailing Address - Country:US
Mailing Address - Phone:503-266-5541
Mailing Address - Fax:503-266-5544
Practice Address - Street 1:1577 S IVY ST
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-4334
Practice Address - Country:US
Practice Address - Phone:503-266-5541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-04
Last Update Date:2017-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR350944224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant