Provider Demographics
NPI:1396920583
Name:BARTLETT-OCOBOCK, JOY SUPREME
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:SUPREME
Last Name:BARTLETT-OCOBOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6415 NE KILLINGSWORTH ST UNIT G17
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-3072
Mailing Address - Country:US
Mailing Address - Phone:503-431-1366
Mailing Address - Fax:
Practice Address - Street 1:9111 NE SUNDERLAND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-1708
Practice Address - Country:US
Practice Address - Phone:503-280-6081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)