Healthcare Provider Details

I. General information

NPI: 1174117600
Provider Name (Legal Business Name): TYLER MARIE HILL LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 02/25/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JAMES A TAYLOR CAMPUS HEALTH SERVICES CB#7470
CHAPEL HILL NC
27599-0001
US

IV. Provider business mailing address

101 ROCK HAVEN RD APT C303
CARRBORO NC
27510-2577
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-3655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number4188
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: