Healthcare Provider Details

I. General information

NPI: 1396289567
Provider Name (Legal Business Name): ALICIA HURPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 STORMONT ST
NEW CONCORD OH
43762-1118
US

IV. Provider business mailing address

9829 MEADOW WOOD DR
PICKERINGTON OH
43147-8969
US

V. Phone/Fax

Practice location:
  • Phone: 740-826-8237
  • Fax: 740-826-6123
Mailing address:
  • Phone: 440-862-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT 003091
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: