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General NPI Number Information
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NPI Number | 1982351870
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Entity Type | Individual
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Provider Name | MAKAYLA MCAVOY AT
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Gender | Female
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Dates
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Enumeration Date | 03/09/2022
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 701 N CLINTON ST
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City | DEFIANCE
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State | OH
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Zip | 43512-1610
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Country | US
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Telephone | 419-783-2379
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Fax |
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Provider Business Mailing Address
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Address Line | 1229 SCHULTZ ST
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City | DEFIANCE
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State | OH
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Zip | 43512-2915
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Country | US
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Telephone | 740-361-0636
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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 | AT005641
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License Number State | OH
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