Basic Information
Provider Information
NPI: 1699179382
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JAMES
FirstName: VICTORIA
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential:  
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OtherFirstName:  
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Mailing Information
Address1: PO BOX 4105
Address2:  
City: PORTLAND
State: OR
PostalCode: 972084105
CountryCode: US
TelephoneNumber: 8669071068
FaxNumber: 4259179141
Practice Location
Address1: 3330 PROVIDENCE DRIVE
Address2: SUITE B201
City: ANCHORAGE
State: AK
PostalCode: 99508
CountryCode: US
TelephoneNumber: 9072123116
FaxNumber: 9072122570
Other Information
ProviderEnumerationDate: 10/09/2014
LastUpdateDate: 12/03/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/01/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X115131AKY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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