Individual
LAURA WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
615 NE 15TH ST, MCMINNVILLE, OR 97128-3399
(503) 565-4200
Mailing address
2143 WELLS DR, HOOD RIVER, OR 97031-8443
(541) 399-0570
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
ATAT10185313
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ATAT10185313
OREGON HEALTH LICENCING BOARD
OR
Enumeration date
03/07/2019
Last updated
03/07/2019
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