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General NPI Number Information
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NPI Number | 1295402071
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Entity Type | Individual
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Provider Name | LAYNE AVERY COURTER ATC
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Gender | Female
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Dates
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Enumeration Date | 08/27/2021
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Last Update Date | 08/27/2021
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Provider Practice Location Address
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Address Line | 1839 ASHTON LN APT 177B
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City | KENT
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State | OH
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Zip | 44240-8132
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Country | US
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Telephone | 804-839-0779
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Fax |
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Provider Business Mailing Address
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Address Line | 6338 LITTLE SORREL DR
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-4480
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Country | US
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Telephone | 804-839-0779
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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 | AT006466
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License Number State | OH
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