Healthcare Provider Details

I. General information

NPI: 1528120565
Provider Name (Legal Business Name): ABAGAIL EVONNE COATES ATC, LAT, PES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 CHESTER BLVD
RICHMOND IN
47374-1908
US

IV. Provider business mailing address

919 NW C ST
RICHMOND IN
47374-4067
US

V. Phone/Fax

Practice location:
  • Phone: 765-983-3092
  • Fax:
Mailing address:
  • Phone: 219-771-0742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36001125A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number002619
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: