Provider Demographics
NPI:1245366913
Name:ATKINSON, TANA RAE (OTR)
Entity type:Individual
Prefix:MRS
First Name:TANA
Middle Name:RAE
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2262 BANYONWOOD AVE NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-1341
Mailing Address - Country:US
Mailing Address - Phone:503-580-5475
Mailing Address - Fax:503-362-6071
Practice Address - Street 1:2262 BANYONWOOD AVE NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-1341
Practice Address - Country:US
Practice Address - Phone:503-580-5475
Practice Address - Fax:503-362-6071
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1003215225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR206974Medicaid