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General NPI Number Information
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NPI Number | 1790169860
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Entity Type | Organization
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Legal Business Name | NATIONWIDE CHILDREN'S HOSPITAL
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 07/17/2015
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Provider Practice Location Address
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Address Line | 584 COUNTY LINE RD W
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City | WESTERVILLE
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State | OH
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Zip | 43082-7245
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Country | US
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Telephone | 614-355-6090
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Fax |
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Provider Business Mailing Address
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Address Line | 584 COUNTY LINE RD W
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City | WESTERVILLE
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State | OH
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Zip | 43082-7245
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SPORTS MEDICINE PROGRAM MANAGER
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Name | LISA KLUCHUROSKY
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Credential |
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Telephone | 614-355-6020
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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 | AT.004136
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License Number State | OH
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