Winston D Davenport, ATC
Specialist/Technologist, Athletic Trainer in Corvallis, OR. Individual provider (NPI-1).
NPI number1710510185
StatusActive
Last updated in NPPESFeb 13, 2020
Details
- NPI
- 1710510185
- Entity type
- Individual (NPI-1)
- Name
- Mr. Winston D Davenport
- Credential
- ATC
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Feb 13, 2020
- Certification date
- Feb 13, 2020
- Last updated
- Feb 13, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | AT-AT-10171037 | OR | Yes |
Practice location
325 Valley Football CtrCorvallis, OR 97331-8544
Phone 541-243-4004
Mailing address
1597 Nw Terracegreen PlCorvallis, OR 97330-1347
Phone 541-243-4004
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