Provider Demographics
NPI:1164927356
Name:CHANEY, KENDRA AUGUSTINE (ATC)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:AUGUSTINE
Last Name:CHANEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7325 SW CHILDS RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7713
Mailing Address - Country:US
Mailing Address - Phone:361-537-8901
Mailing Address - Fax:
Practice Address - Street 1:7325 SW CHILDS RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-7713
Practice Address - Country:US
Practice Address - Phone:361-537-8901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORATAT101790312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer