Healthcare Provider Details

I. General information

NPI: 1902871395
Provider Name (Legal Business Name): ALLYSON LEE BARTON ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 SW 4TH AVE
ONTARIO OR
97914-2633
US

IV. Provider business mailing address

840 SW 4TH AVE
ONTARIO OR
97914-2633
US

V. Phone/Fax

Practice location:
  • Phone: 541-709-1211
  • Fax:
Mailing address:
  • Phone: 541-709-1211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number67-000925
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-488
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATAT10158311
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: