Active NPI
Stefanie J Born, ATC
- Athletic Trainer
- Gresham, OR
National Provider Identifier
1659429082
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT-AT-1001505
- Practice address
- 24076 SE Stark St
Suite 200
Gresham, OR 97030-3373 - Phone
- (503) 491-1666
- Fax
- (503) 491-1667
- NPI assigned
- Jan 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT-AT-1001505 | OR | Primary |
Addresses
Primary practice location
24076 SE Stark St
Suite 200
Gresham, OR 97030-3373
Mailing address
765 SE Mount Hood Hwy
#J271
Gresham, OR 97080-7131
Phone (503) 666-6549
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT-AT-1001505 | OR | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1659429082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "765 SE MOUNT HOOD HWY",
"address_2": "#J271",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970807131",
"telephone_number": "503-666-6549"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24076 SE STARK ST",
"address_2": "SUITE 200",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970303373",
"telephone_number": "503-491-1666",
"fax_number": "503-491-1667"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORN",
"first_name": "STEFANIE",
"middle_name": "J",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OR",
"license": "AT-AT-1001505",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.