Healthcare Provider Details

I. General information

NPI: 1508380213
Provider Name (Legal Business Name): LUCIA MARIE PICCIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 MARSHALL RD
MARIETTA OH
45750-1159
US

IV. Provider business mailing address

114 MARSHALL RD
MARIETTA OH
45750-1159
US

V. Phone/Fax

Practice location:
  • Phone: 740-516-0761
  • Fax:
Mailing address:
  • Phone: 740-516-0761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: