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General NPI Number Information
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NPI Number | 1699449058
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Entity Type | Individual
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Provider Name | ALEXA HAMBLY
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Gender | Female
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Dates
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Enumeration Date | 08/09/2021
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Last Update Date | 08/09/2021
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Provider Practice Location Address
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Address Line | 1 PROSPECT ST
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City | PROVIDENCE
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State | RI
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Zip | 02912-9127
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Country | US
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Telephone | 401-863-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 39 FIELDSTONE CIR
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City | MIDDLEBORO
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State | MA
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Zip | 02346-3129
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Country | US
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Telephone | 774-281-8232
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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 | 3475
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License Number State | MA
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