Healthcare Provider Details

I. General information

NPI: 1770413437
Provider Name (Legal Business Name): HAILEY NICOLE HOWELL AT, OPE-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/24/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 STADIUM DR
NEW CONCORD OH
43762-1146
US

IV. Provider business mailing address

290 ELM ST
DUNCAN FALLS OH
43734-9702
US

V. Phone/Fax

Practice location:
  • Phone: 740-586-2064
  • Fax:
Mailing address:
  • Phone: 740-586-2064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT007327
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: