Provider Demographics
NPI:1295580710
Name:AHADI, AZITA NARGES (MOT/ OTR/L)
Entity type:Individual
Prefix:
First Name:AZITA
Middle Name:NARGES
Last Name:AHADI
Suffix:
Gender:F
Credentials:MOT/ OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13455 SE 97TH AVE
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-8662
Mailing Address - Country:US
Mailing Address - Phone:503-675-4000
Mailing Address - Fax:
Practice Address - Street 1:13455 SE 97TH AVE
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8662
Practice Address - Country:US
Practice Address - Phone:503-675-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1055803225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics