Individual
AMY CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, MA
Contact information
Practice address
8950 N KELLOGG ST APT 6, PORTLAND, OR 97203-3052
(509) 336-9231
Mailing address
5000 N WILLAMETTE BLVD, PORTLAND, OR 97203-5743
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-AT-10165214
OR
Other
Enumeration date
03/29/2018
Last updated
03/29/2018
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