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General NPI Number Information
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NPI Number | 1316099666
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Entity Type | Individual
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Provider Name | STEPHANIE E BLACK ATC
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Gender | Female
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 950 W WOOSTER ST
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City | BOWLING GREEN
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State | OH
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Zip | 43402-2603
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Country | US
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Telephone | 419-354-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 432 BUTTONWOOD AVE
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City | BOWLING GREEN
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State | OH
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Zip | 43402-3715
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Country | US
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Telephone | 419-807-8344
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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 | AT2254
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License Number State | OH
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