Provider Demographics
NPI:1265274435
Name:BORING, MELISSA (OTA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BORING
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16550 SE 232ND DR
Mailing Address - Street 2:
Mailing Address - City:BORING
Mailing Address - State:OR
Mailing Address - Zip Code:97089-8182
Mailing Address - Country:US
Mailing Address - Phone:503-804-5634
Mailing Address - Fax:
Practice Address - Street 1:16550 SE 232ND DR
Practice Address - Street 2:
Practice Address - City:BORING
Practice Address - State:OR
Practice Address - Zip Code:97089-8182
Practice Address - Country:US
Practice Address - Phone:503-804-5634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1067392224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant