Healthcare Provider Details

I. General information

NPI: 1871137802
Provider Name (Legal Business Name): ALEXA NOELLE BREWSTER ATHLETIC TRAINER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2019
Last Update Date: 11/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 EMBASSY PKWY STE A
AKRON OH
44333-8319
US

IV. Provider business mailing address

1214 ANDY DR
STREETSBORO OH
44241-4910
US

V. Phone/Fax

Practice location:
  • Phone: 330-668-4055
  • Fax:
Mailing address:
  • Phone: 330-564-6939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT005577
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: