=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851610109
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICK O HUNTER ATC, AT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2010
-----------------------------------------------------
Last Update Date | 05/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 651 W MARION RD
-----------------------------------------------------
City | MOUNT GILEAD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43338-1027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-949-3086
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39 N PRESTON ST
-----------------------------------------------------
City | CENTERBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43011-7083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-709-5277
-----------------------------------------------------
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 | AT-1960
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------