Provider Demographics
NPI:1255380655
Name:VON HAMMERSTEIN, CLAUDIA MARIE (PT)
Entity type:Individual
Prefix:MS
First Name:CLAUDIA
Middle Name:MARIE
Last Name:VON HAMMERSTEIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CLAUDIA
Other - Middle Name:MARIE
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1130 NW 22ND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2900
Mailing Address - Country:US
Mailing Address - Phone:503-413-7753
Mailing Address - Fax:503-413-8024
Practice Address - Street 1:1040 NW 22ND AVE
Practice Address - Street 2:SUITE LL015
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3057
Practice Address - Country:US
Practice Address - Phone:503-413-7753
Practice Address - Fax:503-413-7753
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR181595Medicaid
ORP84213Medicare UPIN
OR181595Medicaid