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General NPI Number Information
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NPI Number | 1851134969
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Entity Type | Individual
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Provider Name | EMILY LODGE
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Gender | Female
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Dates
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Enumeration Date | 06/17/2024
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 615 IRVING SCHOTTENSTEIN DR
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City | COLUMBUS
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State | OH
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Zip | 43210-1069
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Country | US
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Telephone | 484-949-4977
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Fax |
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Provider Business Mailing Address
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Address Line | 2205 ACADIA TRAIL DR APT 108
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City | COLUMBUS
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State | OH
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Zip | 43228-4001
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Country | US
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Telephone | 484-949-4977
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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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