Dana Agenbroad
Individual provider Active NPI Occupational Therapy Assistant · Springfield, OR
NPI 1578985461 · NPPES record last updated Jan 10, 2014
Key facts
- NPI
- 1578985461
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 1048112 (OR)
- Practice address
- 1333 N 1St St
Springfield, OR 97477-3002 - Phone
- (541) 736-2728
- NPI assigned
- Jan 10, 2014
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1048112 | OR | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 1048112 | OR | Yes |
Addresses
Primary practice location
1333 N 1St St
Springfield, OR 97477-3002
Mailing address
1358 32ND St
Springfield, OR 97478-5523
Phone (541) 736-0035
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All providers in Springfield, OR · Occupational Therapy Assistant in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 10, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.