Healthcare Provider Details

I. General information

NPI: 1194150391
Provider Name (Legal Business Name): CASEY LYNN LINK AT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HIGH SCHOOL RD
THE PLAINS OH
45780-1148
US

IV. Provider business mailing address

15 S SHAFER ST APARTMENT 1102
ATHENS OH
45701-2795
US

V. Phone/Fax

Practice location:
  • Phone: 954-632-5338
  • Fax:
Mailing address:
  • Phone: 954-632-5338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number003914
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: