MEDICARE: ASHLEY HARTWELL ATC

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	1829	MA

General Provider Information

NPI Number	:	1194125450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY HARTWELL ATC

Provider Business Mailing Address
First Line	:	1071 BLUE HILL AVE
Second Line	:
City	:	MILTON
State	:	MA
Zip	:	02186-2302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1071 BLUE HILL AVE
Second Line	:
City	:	MILTON
State	:	MA
Zip	:	02186-2302
Country	:	US
Telephone Number	:	603-562-5653
Fax Number	:

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

Provider Enumeration Date	:	08/23/2014
Last Update Date	:	08/23/2014

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Directions to “ ASHLEY HARTWELL ATC” Practice Location

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