MEDICARE: TOIVON A MAIA

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

General Provider Information

NPI Number	:	1295290898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOIVON A MAIA

Provider Business Mailing Address
First Line	:	1 COLONIAL CT
Second Line	:
City	:	WOLCOTT
State	:	CT
Zip	:	06716-2962
Country	:	US
Telephone Number	:	203-704-7859
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 COLONIAL CT
Second Line	:
City	:	WOLCOTT
State	:	CT
Zip	:	06716-2962
Country	:	US
Telephone Number	:	203-704-7859
Fax Number	:

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

Provider Enumeration Date	:	02/07/2019
Last Update Date	:	02/07/2019

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Directions to “ TOIVON A MAIA ” Practice Location

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