Provider Demographics
NPI:1619028297
Name:OREGON TRAIL SCHOOL DISTRICT
Entity type:Organization
Organization Name:OREGON TRAIL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL SERVICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:EPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-668-4949
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:36520 SE PROCTOR ROAD
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-0547
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36520 SE PROCTOR ROAD
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-0547
Practice Address - Country:US
Practice Address - Phone:503-668-4949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR070962Medicaid