Individual
KIM DEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1235 OVERLOOK DR, LAKE OSWEGO, OR 97034-6945
(503) 534-2407
Mailing address
1235 OVERLOOK DR, LAKE OSWEGO, OR 97034-6945
(503) 534-2407
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
ATAT1007932
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ATAT1007932
OHLA
OR
Enumeration date
11/15/2007
Last updated
11/15/2007
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