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General NPI Number Information
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NPI Number | 1356404040
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Entity Type | Individual
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Provider Name | AMY LEANNE HAYFORD ATC
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Gender | Female
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4848 N HOLLAND SYLVANIA RD SUITE 202
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City | SYLVANIA
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State | OH
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Zip | 43560-2170
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Country | US
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Telephone | 419-824-1323
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Fax | 419-885-5179
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Provider Business Mailing Address
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Address Line | 429 N MONROE ST
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City | BLISSFIELD
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State | MI
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Zip | 49228-1064
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Country | US
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Telephone | 517-486-6248
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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 | 00645
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License Number State | OH
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