Healthcare Provider Details

I. General information

NPI: 1912446196
Provider Name (Legal Business Name): LAUREN WHITE ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 HARRISON AVE SUITE I
CINCINNATI OH
45248-2361
US

IV. Provider business mailing address

1641 TUNIS DR
HARRISON OH
45030-2835
US

V. Phone/Fax

Practice location:
  • Phone: 513-661-3114
  • Fax:
Mailing address:
  • Phone: 513-505-4497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT004131
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: