Provider Demographics
NPI:1750326344
Name:ETHEL-KING, MELODIE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MELODIE
Middle Name:
Last Name:ETHEL-KING
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 SW BEAVERTON HILLSDALE HWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3315
Mailing Address - Country:US
Mailing Address - Phone:503-684-7246
Mailing Address - Fax:503-624-0724
Practice Address - Street 1:9400 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:SUITE 205
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3315
Practice Address - Country:US
Practice Address - Phone:503-684-7246
Practice Address - Fax:503-624-0724
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR#986473225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist