Healthcare Provider Details

I. General information

NPI: 1437206034
Provider Name (Legal Business Name): DEBBI GREEN ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 SOUTHGATE
PENDLETON OR
97801-3845
US

IV. Provider business mailing address

3086 SW OVERLOOK PL
PENDLETON OR
97801-8006
US

V. Phone/Fax

Practice location:
  • Phone: 541-278-6610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-AT-383513
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: