MEDICARE: MR. DANIEL ZERAH HOOVER A.T.,C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AT-000567	OH

General Provider Information

NPI Number	:	1013981521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL ZERAH HOOVER A.T.,C.

Provider Business Mailing Address
First Line	:	PO BOX 125
Second Line	:
City	:	ROCKY RIDGE
State	:	OH
Zip	:	43458-0125
Country	:	US
Telephone Number	:	419-898-5625
Fax Number	:

Provider Business Practice Location Address
First Line	:	11661 W STATE ROUTE 163
Second Line	:
City	:	OAK HARBOR
State	:	OH
Zip	:	43449-1278
Country	:	US
Telephone Number	:	419-898-6216
Fax Number	:	419-898-0116

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	07/08/2007

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