Provider Demographics
NPI:1538845409
Name:FLORES, CARL (OTR/L)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:
Last Name:FLORES
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:MR
Other - First Name:CARL
Other - Middle Name:
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3320 SE KELLY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202
Mailing Address - Country:US
Mailing Address - Phone:954-260-5372
Mailing Address - Fax:
Practice Address - Street 1:3320 SE KELLY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202
Practice Address - Country:US
Practice Address - Phone:954-260-5372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR418876225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist