Kim Deaver, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

ATAT1007932 Issued in OR

Practice address

1235 Overlook Dr
Lake Oswego, OR 97034-6945

Phone

(503) 534-2407

NPI assigned

Nov 15, 2007

Last updated

Nov 15, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

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.

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195084800000",
    "number": "1760663918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 OVERLOOK DR",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970346945",
            "telephone_number": "503-534-2407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 OVERLOOK DR",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970346945",
            "telephone_number": "503-534-2407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEAVER",
        "first_name": "KIM",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-15",
        "last_updated": "2007-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "OR",
            "license": "ATAT1007932",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHLA",
            "identifier": "ATAT1007932",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chantelle De Jager
• Victoria Alysse De la Llama, LCSW
• Nancy Lynn De Turk, LMT
• Laila Deardorff, P.T.
• Isabel Deaver, LPC
• Eleanor B Debakker, PT
• Deborah Mertlich, LCSW
• Samantha Dela Cruz
• Cyndee Delarocha, MASSAGE THERAPIST
• Deni R Buss, LMT (Deni R Buss)

• Athletic Trainer in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• Athletic Trainer in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 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.

Verify at the official NPI Registry.