MEDICARE: CANDACE NORMAN MED, AT

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	02000	OH

General Provider Information

NPI Number	:	1588004790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE NORMAN MED, AT

Provider Business Mailing Address
First Line	:	14265 DECHANT RD
Second Line	:
City	:	FARMERSVILLE
State	:	OH
Zip	:	45325-9240
Country	:	US
Telephone Number	:	937-545-0172
Fax Number	:

Provider Business Practice Location Address
First Line	:	14265 DECHANT RD
Second Line	:
City	:	FARMERSVILLE
State	:	OH
Zip	:	45325-9240
Country	:	US
Telephone Number	:	937-545-0172
Fax Number	:

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

Provider Enumeration Date	:	07/02/2013
Last Update Date	:	07/02/2013

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