=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437685575
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY ELIZABETH GUSEW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2017
-----------------------------------------------------
Last Update Date | 05/10/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | SLU 10309
-----------------------------------------------------
City | HAMMOND
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70402-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-549-5437
-----------------------------------------------------
Fax | 985-549-2511
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1502 W CHURCH ST APT. E
-----------------------------------------------------
City | HAMMOND
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70401-2959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-592-5734
-----------------------------------------------------
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 | ATH.200355
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------