| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JAMISON KEITH CARROLL | 1568052595 | 2023-02-21 |
Jamison Keith Carroll is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1568052595. Registration indicates Jamison Keith Carroll is a provider of services with a specialization in Respiratory, Developmental, Rehabilitative and Restorative Service Providers, Occupational Therapist (Occupational Therapist, ) (Speech/Occupational/Physical Therapy/Chiropractor, ) (Occupational Therapist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers) (Respiratory, Developmental, Rehabilitative and Restorative Service Providers, Occupational Therapist) (Occupational Therapist, ) (Speech/Occupational/Physical Therapy/Chiropractor, ) (Occupational Therapist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers)
| Entity Type | Individual |
| Provider Name | Mr. Jamison Keith Carroll OTR/L |
| Practice Office Address | 9370 SW GREENBURG RD PORTLAND, OR US |
| Practice Office Telephone | 5032005750 |
| Mailing Address | 11683 SW TEAL BLVD APT M BEAVERTON, OR 970077969 US |
| Business Telephone | 4352136134 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 11683 SW Teal Blvd Apt M | Beaverton, OR 970077969 | 4352136134 |
| 2217 Country Club Rd | Woodburn, OR 970712811 | 5039824200 / 5039812323 |
| 8995 SW Miley Rd | Wilsonville, OR 970705484 | 5036948366 / 5036948581 |
| Code | Practice | License No State |
|---|---|---|
| 225X00000X PRIMARY | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Occupational Therapist Occupational Therapist Speech/Occupational/Physical Therapy/Chiropractor Occupational Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers | 447328
OR |
| 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Occupational Therapist Occupational Therapist Speech/Occupational/Physical Therapy/Chiropractor Occupational Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers | OTH-008360
AZ |
| 1568052595 | MEDICAID | OR |