Healthcare Provider Details

I. General information

NPI: 1417467119
Provider Name (Legal Business Name): NATALIE MARIE DRAGOVICH ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2017
Last Update Date: 10/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9228 SHEPARD RD
MACEDONIA OH
44056-1454
US

IV. Provider business mailing address

9228 SHEPARD RD
MACEDONIA OH
44056-1454
US

V. Phone/Fax

Practice location:
  • Phone: 330-774-8783
  • Fax:
Mailing address:
  • Phone: 330-774-8783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberSR906357
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: