Healthcare Provider Details

I. General information

NPI: 1326547605
Provider Name (Legal Business Name): KALEIGH ANNE PHILLIPS ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2054 APPLEGATE ST
PHILOMATH OR
97370-9354
US

IV. Provider business mailing address

1542 WALLACE RD NW APT 121
SALEM OR
97304-2672
US

V. Phone/Fax

Practice location:
  • Phone: 805-218-4283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: