Healthcare Provider Details

I. General information

NPI: 1437185568
Provider Name (Legal Business Name): ALLISON JOEL HANNAH ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: ALLISON MARIE JOEL ATC

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2565 EDGEWOOD AVE
ALLIANCE OH
44601-4613
US

IV. Provider business mailing address

2565 EDGEWOOD AVE
ALLIANCE OH
44601-4613
US

V. Phone/Fax

Practice location:
  • Phone: 330-257-1292
  • Fax:
Mailing address:
  • Phone: 330-257-1292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: