Healthcare Provider Details

I. General information

NPI: 1508786625
Provider Name (Legal Business Name): SELINA VISCETTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 N 1ST ST
CENTRAL POINT OR
97502-2069
US

IV. Provider business mailing address

73 N 1ST ST
CENTRAL POINT OR
97502-2069
US

V. Phone/Fax

Practice location:
  • Phone: 541-665-8120
  • Fax:
Mailing address:
  • Phone: 541-665-8120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberBAP-TA-10209288
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: