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General NPI Number Information
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NPI Number | 1952840142
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Entity Type | Individual
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Provider Name | MEGHAN JEAN WHITMORE ATC
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Gender | Female
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Dates
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Enumeration Date | 02/21/2017
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Last Update Date | 01/15/2020
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Provider Practice Location Address
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Address Line | 5824 WIDEWATERS PKWY
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-3072
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Country | US
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Telephone | 315-380-3475
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Fax |
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Provider Business Mailing Address
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Address Line | 3137 HADLEY LN
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City | BALDWINSVILLE
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State | NY
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Zip | 13027-1713
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Country | US
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Telephone | 315-436-9017
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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 | 002360-1
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License Number State | NY
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