=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659316297
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONICA LYNN DELL ATC, LAT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 WILSON CREEK PKWY
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75069-5320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-742-5953
-----------------------------------------------------
Fax | 469-742-5843
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1017 WINDSOR DR
-----------------------------------------------------
City | SHERMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75092-2455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-821-8006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | AT1808
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------