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General NPI Number Information
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NPI Number | 1124107891
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Entity Type | Individual
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Provider Name | SCOTT ALAN HICKMAN ATC, CSCS, USAW
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Gender | Male
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 10/26/2009
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Provider Practice Location Address
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Address Line | 1 WILDCAT LN
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City | BROOKVILLE
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State | IN
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Zip | 47012-8100
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Country | US
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Telephone | 765-647-4101
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Fax |
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Provider Business Mailing Address
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Address Line | 9017 TREMONT PL
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City | BROOKVILLE
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State | IN
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Zip | 47012-7769
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Country | US
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Telephone | 765-207-0226
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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 | 36000577A
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License Number State | IN
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