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General NPI Number Information
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NPI Number | 1487058343
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Entity Type | Individual
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Provider Name | ALYSSA COLLEEN TENDALL STOUT ATC
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Gender | Female
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Dates
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Enumeration Date | 10/21/2014
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Last Update Date | 02/11/2019
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Provider Practice Location Address
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Address Line | 215 5TH ST
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City | MARIETTA
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State | OH
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Zip | 45750-4033
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Country | US
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Telephone | 740-376-4575
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Fax |
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Provider Business Mailing Address
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Address Line | 215 5TH ST
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City | MARIETTA
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State | OH
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Zip | 45750-4033
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Country | US
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Telephone | 515-231-1327
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | AT005607
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT005607
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | AT005607
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License Number State | OH
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