Provider Demographics
NPI:1528293404
Name:RYAN DOUGLAS GLOVER ARMWORKS HAND THERAPY
Entity type:Organization
Organization Name:RYAN DOUGLAS GLOVER ARMWORKS HAND THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-674-7860
Mailing Address - Street 1:PO BOX 2485
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-0660
Mailing Address - Country:US
Mailing Address - Phone:503-674-7860
Mailing Address - Fax:503-674-7642
Practice Address - Street 1:9100 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-6772
Practice Address - Country:US
Practice Address - Phone:503-794-0103
Practice Address - Fax:503-794-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1023386225X00000X
OR1041100414225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR134505Medicare PIN
OR5725030003Medicare NSC