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General NPI Number Information
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NPI Number | 1295051837
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Entity Type | Individual
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Provider Name | KELLY MARIE CHOUNARD DPT
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Gender | Female
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Dates
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Enumeration Date | 04/07/2010
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Last Update Date | 09/13/2018
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Provider Practice Location Address
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Address Line | 445 HARLOW RD STE 120
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City | SPRINGFIELD
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State | OR
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Zip | 97477-1341
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Country | US
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Telephone | 541-736-8870
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Fax | 541-736-8860
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Provider Business Mailing Address
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Address Line | 16083 SW UPPER BOONES FERRY RD STE 300
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City | TIGARD
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State | OR
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Zip | 97224-7736
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Country | US
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Telephone | 503-443-6156
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Fax | 503-639-9699
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501015069
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT6253
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License Number State | OR
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