Individual
MR. WINSTON D DAVENPORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
325 VALLEY FOOTBALL CTR, CORVALLIS, OR 97331-8544
(541) 243-4004
Mailing address
1597 NW TERRACEGREEN PL, CORVALLIS, OR 97330-1347
(541) 243-4004
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-AT-10171037
OR
Other
Enumeration date
02/13/2020
Last updated
02/13/2020
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