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General NPI Number Information
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NPI Number | 1720284904
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Entity Type | Individual
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Provider Name | STACEY A MAXWELL MS, ATC
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Gender | Female
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 08/05/2007
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Provider Practice Location Address
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Address Line | 1207 LIBERTY RD
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City | ELDERSBURG
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State | MD
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Zip | 21784-6574
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Country | US
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Telephone | 410-549-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 4 BRETON HILL RD APT 2B
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City | PIKESVILLE
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State | MD
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Zip | 21208-3039
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Country | US
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Telephone | 410-486-2692
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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 |
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License Number State |
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