Provider Demographics
NPI:1699977819
Name:ST. AMAND, LAWRENCE GERALD (OTR)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:GERALD
Last Name:ST. AMAND
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15390 NW CORNELL RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-5627
Mailing Address - Country:US
Mailing Address - Phone:971-245-6663
Mailing Address - Fax:971-245-6664
Practice Address - Street 1:15390 NW CORNELL RD
Practice Address - Street 2:SUITE 230
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-5627
Practice Address - Country:US
Practice Address - Phone:971-245-6663
Practice Address - Fax:971-245-6664
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1042243225XH1200X
VA0119006341224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR180472Medicare PIN