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General NPI Number Information
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NPI Number | 1912384272
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Entity Type | Individual
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Provider Name | STEPHANIE MAZEROLLE PHD, ATC
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Gender | Female
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 2095 HILLSIDE RD UNIT 1110 DEPARTMENT OF KINESIOLOGY
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City | STORRS
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State | CT
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Zip | 06269-1110
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Country | US
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Telephone | 860-486-4536
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Fax | 860-486-1123
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Provider Business Mailing Address
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Address Line | 41 WHITNEY RD
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City | COLUMBIA
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State | CT
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Zip | 06237-1034
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Country | US
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Telephone | 860-608-4184
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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 | 000205
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License Number State | CT
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