MEDICARE: MRS. LEAH K PADACA ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AT-10177854	OR

General Provider Information

NPI Number	:	1336593904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEAH K PADACA ATC

Provider Business Mailing Address
First Line	:	2401 SE STARK ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-1759
Country	:	US
Telephone Number	:	208-794-0439
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 SE STARK ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-1759
Country	:	US
Telephone Number	:	208-794-0439
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2016
Last Update Date	:	05/03/2017

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