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General NPI Number Information
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NPI Number | 1487236261
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Entity Type | Individual
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Provider Name | MRS. DEVON FRAKER GATEWOOD
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Gender | Female
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Dates
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Enumeration Date | 04/22/2021
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Last Update Date | 04/22/2021
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Provider Practice Location Address
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Address Line | 8500 OTTERBURN RD
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City | AMELIA COURT HOUSE
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State | VA
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Zip | 23002-4849
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Country | US
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Telephone | 610-551-7744
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Fax |
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Provider Business Mailing Address
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Address Line | 437 GRAVEL HILL RD
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City | FORK UNION
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State | VA
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Zip | 23055-2104
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Country | US
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Telephone | 610-551-7744
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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 | 0126001869
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License Number State | VA
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