Provider Demographics
NPI:1982078358
Name:NORTHWEST MOBILE THERAPY
Entity Type:Organization
Organization Name:NORTHWEST MOBILE THERAPY
Other - Org Name:DAVID NUNN
Other - Org Type:Other Name
Authorized Official - Title/Position:OT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNN
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:971-219-3656
Mailing Address - Street 1:1335 NE 63RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-4905
Mailing Address - Country:US
Mailing Address - Phone:971-219-3656
Mailing Address - Fax:
Practice Address - Street 1:1335 NE 63RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-4905
Practice Address - Country:US
Practice Address - Phone:971-219-3656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-22
Last Update Date:2015-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty