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General NPI Number Information
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NPI Number | 1023568797
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Entity Type | Individual
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Provider Name | CLAIRE BONNORONT LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 10/06/2016
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Last Update Date | 08/08/2020
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Provider Practice Location Address
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Address Line | 320 STANLEY AVE
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City | GREENWOOD
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State | SC
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Zip | 29649-2099
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Country | US
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Telephone | 937-658-2212
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Fax |
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Provider Business Mailing Address
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Address Line | 125 EDINBOROUGH CIR APT 4
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City | GREENWOOD
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State | SC
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Zip | 29649-1339
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Country | US
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Telephone | 937-658-2212
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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 | SC529906
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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