Provider Demographics
NPI:1891761326
Name:VOTAW, LUVONNE T (BSOT)
Entity Type:Individual
Prefix:
First Name:LUVONNE
Middle Name:T
Last Name:VOTAW
Suffix:
Gender:F
Credentials:BSOT
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 356
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:OR
Mailing Address - Zip Code:97115-0356
Mailing Address - Country:US
Mailing Address - Phone:503-538-7587
Mailing Address - Fax:
Practice Address - Street 1:120 N EVEREST RD
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2116
Practice Address - Country:US
Practice Address - Phone:503-538-8952
Practice Address - Fax:503-537-2027
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR643155225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR113380Medicare ID - Type Unspecified