Provider Demographics
NPI:1265801179
Name:KLINEVA, NADEZDA (COTA)
Entity type:Individual
Prefix:
First Name:NADEZDA
Middle Name:
Last Name:KLINEVA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ROSA LUKSEMBURG 10, ARMAVIR, KRASNODAR REGION, 352900,
Mailing Address - Street 2:
Mailing Address - City:ARMAVIR
Mailing Address - State:KRASNODAR REGION
Mailing Address - Zip Code:352900
Mailing Address - Country:RU
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6975 SW NYBERG ST APT V103
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8233
Practice Address - Country:US
Practice Address - Phone:971-277-0136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR340078224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant