Healthcare Provider Details

I. General information

NPI: 1649668963
Provider Name (Legal Business Name): MARK ANDREW FOLEY ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 SPENCER ST
MARION OH
43302-4420
US

IV. Provider business mailing address

131 SPENCER ST
MARION OH
43302-4420
US

V. Phone/Fax

Practice location:
  • Phone: 740-262-9343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT.004604
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: