Provider Demographics
NPI:1669009817
Name:D'AGOSTINO, EMILY NICOLE (MS, OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:NICOLE
Last Name:D'AGOSTINO
Suffix:
Gender:F
Credentials:MS, OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 SW GRIFFITH DR.
Mailing Address - Street 2:SUITE 157
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005
Mailing Address - Country:US
Mailing Address - Phone:503-517-8555
Mailing Address - Fax:503-517-8556
Practice Address - Street 1:4900 SW GRIFFITH DRIVE
Practice Address - Street 2:SUITE 157
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005
Practice Address - Country:US
Practice Address - Phone:503-517-8555
Practice Address - Fax:503-517-8556
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18589225X00000X
OR397299225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist