Provider Demographics
NPI:1134363641
Name:BASS, OLIVIA JEANNE (MOTR/L)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:JEANNE
Last Name:BASS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:JEANNE
Other - Last Name:NORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11855 NE GLENN WIDING DR BLDG F
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-9057
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11855 NE GLENN WIDING DR BLDG F
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-9057
Practice Address - Country:US
Practice Address - Phone:503-256-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR274905225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist