Active NPI
Campbell Mikush, OT
- Occupational Therapist
- Portland, OR
National Provider Identifier
1093134603
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 324129
- Practice address
- 1675 SW Marlow Ave Ste 200
Portland, OR 97225-5102 - Phone
- (503) 228-6479
- NPI assigned
- Apr 10, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 324129 | OR | Primary |
Addresses
Primary practice location
1675 SW Marlow Ave Ste 200
Portland, OR 97225-5102
Mailing address
1675 SW Marlow Ave Ste 200
Portland, OR 97225-5102
Phone (503) 228-6479
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 324129 | OR | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1397088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437955200000",
"number": "1093134603",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1675 SW MARLOW AVE STE 200",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972255102",
"telephone_number": "503-228-6479"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1675 SW MARLOW AVE STE 200",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972255102",
"telephone_number": "503-228-6479"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIKUSH",
"first_name": "CAMPBELL",
"name_prefix": "Ms.",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-04-10",
"last_updated": "2015-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "OR",
"license": "324129",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.