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General NPI Number Information
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NPI Number | 1114335387
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Entity Type | Individual
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Provider Name | KATELYN MANIACI ATC
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Gender | Female
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Dates
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Enumeration Date | 07/31/2014
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Last Update Date | 07/31/2014
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Provider Practice Location Address
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Address Line | 1860 TOWN CENTER DR STE 300 TOWN CENTER OTHOPAEDIC ASSOCIATES
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City | RESTON
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State | VA
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Zip | 20190-5900
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Country | US
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Telephone | 703-483-4671
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Fax |
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Provider Business Mailing Address
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Address Line | 4717 LAFITTE CT
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City | ALEXANDRIA
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State | VA
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Zip | 22312-1612
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Country | US
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Telephone | 810-599-4101
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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 | 0126002150
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License Number State | VA
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