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General NPI Number Information
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NPI Number | 1578039285
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Entity Type | Individual
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Provider Name | MOLLY ELIZABETH ELTRICH AT
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Gender | Female
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Dates
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Enumeration Date | 10/19/2018
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Last Update Date | 10/19/2018
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Provider Practice Location Address
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Address Line | 2835 FRED TAYLOR DR
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City | COLUMBUS
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State | OH
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Zip | 43202-1552
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Country | US
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Telephone | 740-602-2064
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Fax |
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Provider Business Mailing Address
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Address Line | 5001 BANTAM CT
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City | HILLIARD
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State | OH
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Zip | 43026-9520
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Country | US
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Telephone | 740-602-2064
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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 | 002915
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License Number State | OH
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