Provider Demographics
NPI:1902935414
Name:MIGHTY OAKS CHILDREN'S THERAPY CENTER
Entity Type:Organization
Organization Name:MIGHTY OAKS CHILDREN'S THERAPY CENTER
Other - Org Name:MIGHTY OAKS DEVELOPMENTAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:MOT
Authorized Official - Phone:541-967-7551
Mailing Address - Street 1:3615 SPICER DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-7043
Mailing Address - Country:US
Mailing Address - Phone:541-967-7551
Mailing Address - Fax:541-967-5095
Practice Address - Street 1:3615 SPICER DR SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-7043
Practice Address - Country:US
Practice Address - Phone:541-967-7551
Practice Address - Fax:541-967-5095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR7008454OtherBLUE CROSS BLUE SHIELD
OR7008454OtherBLUE CROSS BLUE SHIELD