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General NPI Number Information
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NPI Number | 1922498187
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Entity Type | Individual
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Provider Name | AMBER M TREVINO DAT, M.S, ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 01/27/2015
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 701 COLLEGE RD
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City | LEBANON
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State | IL
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Zip | 62254-1291
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Country | US
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Telephone | 148-829-4297
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Fax |
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Provider Business Mailing Address
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Address Line | 633 ESSEX DR
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-4749
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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 |
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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 | ATH.200342
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 096005802
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License Number State | IL
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