MEDICARE: HARLI RACHELLE BYELENE

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
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1043711583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARLI RACHELLE BYELENE

Provider Business Mailing Address
First Line	:	14109 LOUISVILLE ST NE
Second Line	:
City	:	PARIS
State	:	OH
Zip	:	44669-9783
Country	:	US
Telephone Number	:	330-862-2097
Fax Number	:

Provider Business Practice Location Address
First Line	:	14109 LOUISVILLE ST NE
Second Line	:
City	:	PARIS
State	:	OH
Zip	:	44669-9783
Country	:	US
Telephone Number	:	330-862-2097
Fax Number	:

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

Provider Enumeration Date	:	02/21/2018
Last Update Date	:	02/21/2018

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Directions to “ HARLI RACHELLE BYELENE ” Practice Location

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