Provider Demographics
NPI:1245638352
Name:SIZEMORE, CORRIE
Entity type:Individual
Prefix:
First Name:CORRIE
Middle Name:
Last Name:SIZEMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CORRIE
Other - Middle Name:
Other - Last Name:SIZEMORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC
Mailing Address - Street 1:1801 ECHO HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-7003
Mailing Address - Country:US
Mailing Address - Phone:541-461-6401
Mailing Address - Fax:541-689-7119
Practice Address - Street 1:1801 ECHO HOLLOW RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-7003
Practice Address - Country:US
Practice Address - Phone:541-461-6401
Practice Address - Fax:541-689-7119
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101589922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer