Provider Demographics
NPI:1962904037
Name:UPCHURCH, ARIELLE (COTA)
Entity type:Individual
Prefix:
First Name:ARIELLE
Middle Name:
Last Name:UPCHURCH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4327 SE MASON LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97222-5054
Mailing Address - Country:US
Mailing Address - Phone:830-377-1600
Mailing Address - Fax:
Practice Address - Street 1:6125 SW BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-1019
Practice Address - Country:US
Practice Address - Phone:503-535-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR394782224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant