Provider Demographics
NPI:1760516025
Name:RYAN DOUGLAS GLOVER ARMWORKS HAND THERAPY
Entity Type:Organization
Organization Name:RYAN DOUGLAS GLOVER ARMWORKS HAND THERAPY
Other - Org Name:GRESHAM ARMWORKS HAND THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR, CHT
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 1:24076 SE STARK ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3373
Practice Address - Country:US
Practice Address - Phone:503-491-1666
Practice Address - Fax:503-491-1667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1023386225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5725030001Medicare NSC
ORR134505Medicare PIN