Healthcare Provider Details

I. General information

NPI: 1679488811
Provider Name (Legal Business Name): BENJAMIN KRAMER ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 MONMOUTH ST
INDEPENDENCE OR
97351-1097
US

IV. Provider business mailing address

2145 NW CHRYSTAL DR
MCMINNVILLE OR
97128-2554
US

V. Phone/Fax

Practice location:
  • Phone: 541-419-9323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-10177706
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: