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General NPI Number Information
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NPI Number | 1003200783
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Entity Type | Individual
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Provider Name | MARY ELIZABETH ANKROM ATC
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Gender | Female
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Dates
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Enumeration Date | 03/20/2015
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Last Update Date | 03/20/2015
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Provider Practice Location Address
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Address Line | 501 E. HIGH ST.
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City | OXFORD
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State | OH
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Zip | 45056
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Country | US
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Telephone | 513-529-1809
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Fax |
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Provider Business Mailing Address
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Address Line | 4648 FAIRWAY DR
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City | GENEVA
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State | OH
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Zip | 44041-9781
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Country | US
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Telephone | 440-969-4351
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT.004520
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License Number State | OH
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