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General NPI Number Information
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NPI Number | 1891825998
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Entity Type | Individual
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Provider Name | CASEY R GRAHAM A.T.C
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 PARK PL
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City | ELMIRA
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State | NY
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Zip | 14901-2085
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Country | US
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Telephone | 607-735-1800
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Fax |
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Provider Business Mailing Address
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Address Line | RR 2 BOX 118
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City | PITTSFIELD
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State | PA
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Zip | 16340-9309
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Country | US
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Telephone | 814-688-5160
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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 | 001482
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License Number State | NY
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