=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376102020
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HANNAH LEIGH CLAYTON LAT, ATC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2019
-----------------------------------------------------
Last Update Date | 06/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3480 YORKSHIRE MEDICAL PARK
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40509-1886
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-263-5140
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2240 ROWLAND POND DR
-----------------------------------------------------
City | WILLOW SPRING
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27592-7572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | TCA739
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------