Provider Demographics
NPI:1164831301
Name:BREWER, MCKALEY (ATC/R)
Entity Type:Individual
Prefix:
First Name:MCKALEY
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:ATC/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2954 NE EVANS ST
Mailing Address - Street 2:#60
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-8267
Mailing Address - Country:US
Mailing Address - Phone:206-898-1164
Mailing Address - Fax:
Practice Address - Street 1:2954 NE EVANS ST
Practice Address - Street 2:#60
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-8267
Practice Address - Country:US
Practice Address - Phone:206-898-1164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-101594512255A2300X
WAA1604222202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer