Provider Demographics
NPI:1821305848
Name:PARKER, ANGELA JODEE-GRACE (MOTR/L)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:JODEE-GRACE
Last Name:PARKER
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16886 NW PAISLEY DR.
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4729
Mailing Address - Country:US
Mailing Address - Phone:541-556-4074
Mailing Address - Fax:
Practice Address - Street 1:5711 SW MULTNOMAH BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3145
Practice Address - Country:US
Practice Address - Phone:503-245-7621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLP 2513225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist