Individual
NICOLE PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
390 SE 10TH ST, MADRAS, OR 97741-1573
(207) 333-9413
Mailing address
274 SE HERING RD, MADRAS, OR 97741-9004
(207) 333-9413
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
OR
Other
Enumeration date
12/05/2019
Last updated
12/05/2019
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