Laura Waller, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

ATAT10185313 Issued in OR

Practice address

615 NE 15TH St
McMinnville, OR 97128-3399

Phone

(503) 565-4200

NPI assigned

Mar 7, 2019

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 7, 2019.

{
    "created_epoch": "1551916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551916800000",
    "number": "1386102432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2143 WELLS DR",
            "city": "HOOD RIVER",
            "state": "OR",
            "postal_code": "970318443",
            "telephone_number": "541-399-0570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 NE 15TH ST",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "971283399",
            "telephone_number": "503-565-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "LAURA",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-07",
        "last_updated": "2019-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "OR",
            "license": "ATAT10185313",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON HEALTH LICENCING BOARD",
            "identifier": "ATAT10185313",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Brooke Walker, CRM
• Chris M Walker, QMHA
• Amanda Kaitlin Wallace, RN
• Jewely Wallace
• Rachel J Wallace
• Walmart Inc.
• George Francis Walsh III
• Audrey Wang
• Jerry M Wanitschek-Gilmer, LPC
• Patricia Dawn Ward, R.PH

• All providers in McMinnville, OR
• Athletic Trainer in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.