Provider Demographics
NPI:1962006114
Name:KIDNEY, EMILY RUTH (OTD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:RUTH
Last Name:KIDNEY
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 N LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-1574
Mailing Address - Country:US
Mailing Address - Phone:937-269-5470
Mailing Address - Fax:
Practice Address - Street 1:8625 SW CASCADE AVE STE 320
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-7126
Practice Address - Country:US
Practice Address - Phone:877-755-8940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR414409225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty