Healthcare Provider Details

I. General information

NPI: 1326551466
Provider Name (Legal Business Name): NICOLE SEFCIK M.ED, ATC, CSCS, OTC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2017
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 FRED TAYLOR DR
COLUMBUS OH
43202-1552
US

IV. Provider business mailing address

2835 FRED TAYLOR DR
COLUMBUS OH
43202-1552
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT002315
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: