MEDICARE: MRS. BRANDY VINSON A.T.

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	002653	OH

General Provider Information

NPI Number	:	1972042422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRANDY VINSON A.T.

Provider Business Mailing Address
First Line	:	3624 TAMARACK AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45207-1317
Country	:	US
Telephone Number	:	513-321-3606
Fax Number	:

Provider Business Practice Location Address
First Line	:	1198 SMILEY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-1865
Country	:	US
Telephone Number	:	513-671-6362
Fax Number	:

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

Provider Enumeration Date	:	02/16/2017
Last Update Date	:	02/16/2017

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