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NPI Code Detail

MEDICARE: SHELLEY WISE TAYLOR ATC

MEDICARE: SHELLEY WISE TAYLOR 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
12255A2300XAthletic TrainerSC

General Provider Information

NPI Number : 1437711884
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELLEY WISE TAYLOR ATC
Provider Business Mailing Address
First Line : 5643 PLATT SPRINGS RD
Second Line :
City : LEXINGTON
State : SC
Zip : 29073-9663
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 TARRAR SPRINGS RD
Second Line :
City : LEXINGTON
State : SC
Zip : 29072-3835
Country : US
Telephone Number : 803-821-1000
Fax Number : 803-821-1010
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2019
Last Update Date : 07/06/2019

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Directions to “ SHELLEY WISE TAYLOR ATC” Practice Location

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