Provider Demographics
NPI:1689995896
Name:RYAN DOUGLAS GLOVER ARMWORKS HAND THERAPY
Entity Type:Organization
Organization Name:RYAN DOUGLAS GLOVER ARMWORKS HAND THERAPY
Other - Org Name:HAPPY VALLEY ARMWORKS HAND THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-674-7860
Mailing Address - Street 1:PO BOX 2485
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-0660
Mailing Address - Country:US
Mailing Address - Phone:503-674-7860
Mailing Address - Fax:503-674-7642
Practice Address - Street 1:16126 SE HAPPY VALLEY TOWN CENTER DR
Practice Address - Street 2:#200-J
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-4256
Practice Address - Country:US
Practice Address - Phone:503-427-2956
Practice Address - Fax:503-427-2957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR134505Medicare PIN