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General NPI Number Information
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NPI Number | 1164048518
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Entity Type | Individual
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Provider Name | MARIAH ELLEN STUART
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Gender | Female
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Dates
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Enumeration Date | 06/22/2020
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 101 CHESTNUT ST
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City | BEREA
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State | KY
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Zip | 40403-1516
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Country | US
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Telephone | 859-985-4156
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Fax |
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Provider Business Mailing Address
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Address Line | 814 RIDGEWOOD DR # 2
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City | BEREA
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State | KY
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Zip | 40403-9814
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Country | US
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Telephone | 509-481-0751
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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 |
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License Number State |
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