Healthcare Provider Details

I. General information

NPI: 1396165296
Provider Name (Legal Business Name): CATHLEEN CROWELL ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 LANGTON HALL
CORVALLIS OR
97331-8534
US

IV. Provider business mailing address

220 LANGTON HALL
CORVALLIS OR
97331-8534
US

V. Phone/Fax

Practice location:
  • Phone: 541-737-5491
  • Fax:
Mailing address:
  • Phone: 541-737-5491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-AT-10179754
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: