Individual
BRANDON WALCOTT-AYERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
345 MONMOUTH AVE N, MONMOUTH, OR 97361-1329
(503) 838-8251
Mailing address
3755 SE 10TH AVE, PORTLAND, OR 97202-3713
(925) 212-1093
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000024240
OR
Other
Enumeration date
06/05/2016
Last updated
05/14/2019
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