Provider Demographics
NPI:1962727545
Name:WILLAMETTE HAND THERAPY, LLC
Entity type:Organization
Organization Name:WILLAMETTE HAND THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:AHEARN
Authorized Official - Suffix:
Authorized Official - Credentials:OT, CHT
Authorized Official - Phone:541-485-9907
Mailing Address - Street 1:PO BOX 50056
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-0967
Mailing Address - Country:US
Mailing Address - Phone:541-688-9595
Mailing Address - Fax:
Practice Address - Street 1:1711 WILLAMETTE ST
Practice Address - Street 2:SUITE 302
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4014
Practice Address - Country:US
Practice Address - Phone:541-357-4536
Practice Address - Fax:541-653-9669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR988571225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORDT9264OtherRAIL ROAD MEDICARE
OR6391020001Medicare NSC
ORDT9264OtherRAIL ROAD MEDICARE