Provider Demographics
NPI:1184054926
Name:DANIELSON, AMY (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 NE 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2524
Mailing Address - Country:US
Mailing Address - Phone:971-322-5704
Mailing Address - Fax:
Practice Address - Street 1:9400 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:SUITE 205
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3315
Practice Address - Country:US
Practice Address - Phone:503-684-7246
Practice Address - Fax:503-624-0724
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13817225X00000X
OR315640225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist