Active NPI
Andrea Rae Icenogle
- Occupational Therapist
- Beaverton, OR
National Provider Identifier
1982939179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 241705
- Practice address
- 663 SW 175TH PL
Beaverton, OR 97006-7909 - Phone
- (503) 997-8954
- NPI assigned
- Oct 6, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 241705 | OR | Primary |
| Occupational Therapist | 225X00000X | 4434 | AZ |
Addresses
Primary practice location
663 SW 175TH PL
Beaverton, OR 97006-7909
Mailing address
663 SW 175TH PL
Beaverton, OR 97006-7909
Phone (503) 997-8954
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 |
|---|---|---|---|
| 4434 | AZ | MD | Occupational Therapist |
| 241705 | OR | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254787200000",
"number": "1982939179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "663 SW 175TH PL",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970067909",
"telephone_number": "503-997-8954"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "663 SW 175TH PL",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970067909",
"telephone_number": "503-997-8954"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ICENOGLE",
"first_name": "ANDREA",
"middle_name": "RAE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-10-06",
"last_updated": "2009-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "OR",
"license": "241705",
"primary": true
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AZ",
"license": "4434",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.