Tyler Ichiki, OTR/L
Individual provider Active NPI Hand Occupational Therapist · Gresham, OR
NPI 1902625825 · NPPES record last updated Oct 8, 2024
Key facts
- NPI
- 1902625825
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Hand Occupational Therapist 225XH1200X
- License
- 505784 (OR)
- Practice address
- 24076 SE Stark St Ste 210
Gresham, OR 97030-3376 - Phone
- (503) 491-1666
- NPI assigned
- Oct 8, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sportscare Physical Therapy @ Cornell, LLC
Practice addresses (Care Compare)
24076 SE Stark St
Suite 200
Gresham, OR 97030-3376
Phone (503) 491-1666
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241122004088 | OR | Practitioner - Occupational Therapist in Private Practice | 4688109986 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sportscare Physical Therapy @ Cornell, LLC | Current |
Accepting new patients | |
| Sportscare Physical Therapy @ Cornell, LLC | Hand | Current |
Accepting new patients |
Locations
16100 NW Cornell Rd
Ste 110
Beaverton, OR 97006
Phone (971) 245-6663
10121 SE Sunnyside Rd
Ste 208
Clackamas, OR 97015
Phone (503) 427-2956
24076 SE Stark St
Ste 210
Gresham, OR 97030
Phone (503) 419-1666
24076 SE Stark St
Ste 200
Gresham, OR 97030
Phone (503) 491-1666
3871 Fairview Industrial Dr SE
Ste 120
Salem, OR 97302
Phone (503) 990-6393
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hand Occupational Therapist | 225XH1200X | 505784 | OR | Yes |
Addresses
Primary practice location
24076 SE Stark St Ste 210
Gresham, OR 97030-3376
Mailing address
24076 SE Stark St Ste 210
Gresham, OR 97030-3376
Phone (503) 491-1666
Other providers in Gresham, OR
- Madison Adele Hutton
- Jennifer G Huynh
- Kathryn L Huyssoon
- Sandra S Hwang
- Kasie Renee Hyatt
- Ideal Option, PLLC
- Sakineh Iliaifar X
- Tamara Iliff
- Improvement Chiropractic & Rehab L.L.C.
- Lakisha Inelus
All providers in Gresham, OR · Hand Occupational Therapist in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.