Provider Demographics
NPI:1003213711
Name:GUNNINK, ABIGAIL MICHELLE (MS, ATC)
Entity Type:Individual
Prefix:MS
First Name:ABIGAIL
Middle Name:MICHELLE
Last Name:GUNNINK
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12577 SE RIVER RD
Mailing Address - Street 2:APT 240
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-8007
Mailing Address - Country:US
Mailing Address - Phone:402-689-0278
Mailing Address - Fax:
Practice Address - Street 1:527 SW HALL ST
Practice Address - Street 2:#415
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5230
Practice Address - Country:US
Practice Address - Phone:503-725-4073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-101505852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer