Provider Demographics
NPI:1760051775
Name:ANDERSON, TARYN G (OT)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:G
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 965
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-0965
Mailing Address - Country:US
Mailing Address - Phone:503-318-3927
Mailing Address - Fax:503-981-2323
Practice Address - Street 1:2217 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-2811
Practice Address - Country:US
Practice Address - Phone:503-982-4200
Practice Address - Fax:503-981-2323
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR454818225X00000X, 225XP0019X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR454818OtherSTATE OT LICENSE