Provider Demographics
NPI:1588688568
Name:RUSSELL, ERIN MICHELLE (ATC)
Entity type:Individual
Prefix:MISS
First Name:ERIN
Middle Name:MICHELLE
Last Name:RUSSELL
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 1:6021 NE BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7262
Mailing Address - Country:US
Mailing Address - Phone:503-880-2115
Mailing Address - Fax:
Practice Address - Street 1:2333 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2449
Practice Address - Country:US
Practice Address - Phone:503-359-6145
Practice Address - Fax:503-359-6919
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-2999792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer