Provider Demographics
NPI:1700293776
Name:EMERSON, MAJA KOHL (OTR/L)
Entity Type:Individual
Prefix:
First Name:MAJA
Middle Name:KOHL
Last Name:EMERSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MAJA
Other - Middle Name:ESTHER
Other - Last Name:KOHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1766 SW MARLOW AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5183
Mailing Address - Country:US
Mailing Address - Phone:503-319-9094
Mailing Address - Fax:
Practice Address - Street 1:1766 SW MARLOW AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5183
Practice Address - Country:US
Practice Address - Phone:503-319-9094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR329553225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist