Healthcare Provider Details

I. General information

NPI: 1356327449
Provider Name (Legal Business Name): KARIEL BETH HOAGLAND ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 S CREASY LN STE. 100
LAFAYETTE IN
47905-7433
US

IV. Provider business mailing address

1400 S 22ND ST
LAFAYETTE IN
47905-2054
US

V. Phone/Fax

Practice location:
  • Phone: 765-447-5552
  • Fax:
Mailing address:
  • Phone: 765-742-0633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36001047A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: