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General NPI Number Information
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NPI Number | 1518285105
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Entity Type | Individual
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Provider Name | MEGAN GUSTAEVEL ATC
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Gender | Female
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Dates
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Enumeration Date | 05/07/2010
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Last Update Date | 05/07/2010
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Provider Practice Location Address
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Address Line | 1401 S ARCH AVE
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City | ALLIANCE
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State | OH
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Zip | 44601-4202
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Country | US
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Telephone | 330-821-0201
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Fax |
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Provider Business Mailing Address
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Address Line | 845 LILLY RD
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City | ALLIANCE
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State | OH
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Zip | 44601-3812
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Country | US
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Telephone | 330-581-1536
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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 | AT878
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License Number State | OH
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