Healthcare Provider Details

I. General information

NPI: 1891830006
Provider Name (Legal Business Name): KARI CUNNINGHAM ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13840 NW CORNELL RD
PORTLAND OR
97229-5403
US

IV. Provider business mailing address

6859 NE VININGS WAY APT 735
HILLSBORO OR
97124-7972
US

V. Phone/Fax

Practice location:
  • Phone: 503-259-5130
  • Fax:
Mailing address:
  • Phone: 503-704-0312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-AT-529702
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: