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General NPI Number Information
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NPI Number | 1194459156
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Entity Type | Individual
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Provider Name | ANAIS MOTON LAT, ATC, MBL
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Gender | Female
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Dates
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Enumeration Date | 07/14/2022
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 30 CAMPUS RD
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City | ANNANDALE ON HUDSON
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State | NY
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Zip | 12504-9800
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Country | US
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Telephone | 845-758-7694
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Fax |
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Provider Business Mailing Address
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Address Line | 9 HAWTHORNE AVE
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City | TROY
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State | NY
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Zip | 12180-4714
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Country | US
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Telephone | 224-656-4097
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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 | 003609
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License Number State | NY
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