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General NPI Number Information
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NPI Number | 1083099832
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Entity Type | Individual
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Provider Name | ANNE POLLARD
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Gender | Female
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Dates
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Enumeration Date | 07/22/2015
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 114 GILL COLISEUM SPORTS MEDICINE
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City | CORVALLIS
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State | OR
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Zip | 97331-8547
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Country | US
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Telephone | 541-243-3462
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Fax |
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Provider Business Mailing Address
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Address Line | 114 GILL COLISEUM
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City | CORVALLIS
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State | OR
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Zip | 97331-8547
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Country | US
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Telephone | 541-243-3462
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | ATAT10157823
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License Number State | OR
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