Individual
KIM HANNIGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, ATC
Contact information
Practice address
214 LANGTON HALL, CORVALLIS, OR 97331-8534
(541) 737-5314
Mailing address
214 LANGTON HALL, CORVALLIS, OR 97331-8534
(541) 737-5314
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
306198
OR
Other
Enumeration date
12/06/2018
Last updated
09/15/2020
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