Provider Demographics
NPI:1730743287
Name:CASTRO, KAILEY BRIANNE (OTR/L)
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:BRIANNE
Last Name:CASTRO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15390 NW CORNELL RD STE 230
Mailing Address - Street 2:
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 STE 230
Practice Address - Street 2:
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:2019-04-30
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023409225XP0200X
OR415616225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics