MEDICARE: BETHANY AVRAMAUT AT, 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	19539	OH

General Provider Information

NPI Number	:	1639687429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY AVRAMAUT AT, ATC

Provider Business Mailing Address
First Line	:	7691 PRINCETON PL
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44130-7029
Country	:	US
Telephone Number	:	440-781-6188
Fax Number	:

Provider Business Practice Location Address
First Line	:	13263 CEDAR RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2926
Country	:	US
Telephone Number	:	440-781-6188
Fax Number	:

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

Provider Enumeration Date	:	01/16/2018
Last Update Date	:	01/16/2018

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