Basic Information
Provider Information
NPI: 1073854311
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YATES
FirstName: KARLA
MiddleName: B
NamePrefix:  
NameSuffix:  
Credential: OTR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8909 SW PASTURE CT.
Address2:  
City: TERREBONNE
State: OR
PostalCode: 97760
CountryCode: US
TelephoneNumber: 5416474338
FaxNumber:  
Practice Location
Address1: 7320 SW HUNZZIKER, SUITE 203
Address2:  
City: TIGARD
State: OR
PostalCode: 97223
CountryCode: US
TelephoneNumber: 8883171019
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/12/2013
LastUpdateDate: 03/12/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225XP0019X985863ORY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation

No ID Information.


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