Provider Demographics
NPI:1124793302
Name:EATON, BRIAN (MOTR/L)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:EATON
Suffix:
Gender:M
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 NE ALBERTA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-5062
Mailing Address - Country:US
Mailing Address - Phone:978-886-4433
Mailing Address - Fax:
Practice Address - Street 1:200 S HAZEL DELL WAY STE 210
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-7828
Practice Address - Country:US
Practice Address - Phone:503-263-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR406379225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist