Healthcare Provider Details

I. General information

NPI: 1497241384
Provider Name (Legal Business Name): ALYSIA COHEN ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE UNIVERSITY BLVD FIELD HOUSE, 213
LA GRANDE OR
97850
US

IV. Provider business mailing address

ONE UNIVERSITY BLVD FIELD HOUSE, 213
LA GRANDE OR
97850
US

V. Phone/Fax

Practice location:
  • Phone: 928-606-8274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number10262041
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: