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General NPI Number Information
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NPI Number | 1639700057
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Entity Type | Individual
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Provider Name | LACY L GUNN MS, ATC
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Gender | Female
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Dates
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Enumeration Date | 02/04/2020
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Last Update Date | 02/04/2020
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Provider Practice Location Address
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Address Line | SUNY CORTLAND
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City | CORTLAND
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State | NY
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Zip | 13045
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Country | US
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Telephone | 607-753-4787
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Fax | 607-753-5929
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Provider Business Mailing Address
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Address Line | 4 AUSTIN RD
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City | TULLY
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State | NY
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Zip | 13159-2409
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Country | US
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Telephone | 607-753-4787
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Fax | 607-753-5959
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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 | 002260-1
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License Number State | NY
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