Tye Dewald

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

11073 SE Main St
Milwaukie, OR 97222-7645

Phone

(503) 592-3204

NPI assigned

Dec 10, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Carleigh Dewald Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1544400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544400000000",
    "number": "1982175378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21356 HUBBARD CUTOFF RD NE UNIT 9",
            "city": "AURORA",
            "state": "OR",
            "postal_code": "970028401",
            "telephone_number": "503-592-3204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11073 SE MAIN ST",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972227645",
            "telephone_number": "503-592-3204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEWALD",
        "first_name": "TYE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-12-10",
        "last_updated": "2018-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLEIGH",
            "last_name": "DEWALD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Susan Detar, OCCUPATIONAL THERAPI
• Robert Brian Detorres, DPT
• Mayanna Lynne Dettwyler, COTA/L
• Arun Devaraju
• Lynda Devery
• Patricia Michelle Dexter
• Sarah Dexter
• Dae Diamond-Melendez, OTD, OTR/L, QMHP
• Paola Diaz Hernandez
• Heather Diaz

• Peer Specialist in Milwaukie, OR
• Providers in Milwaukie, OR by specialty
• Peer Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.