MEDICARE: WILLIAM HAROLD PERKINS ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AT000123	OH

General Provider Information

NPI Number	:	1093872335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM HAROLD PERKINS ATC

Provider Business Mailing Address
First Line	:	3578 MONTE VISTA DR
Second Line	:
City	:	BRUNSWICK
State	:	OH
Zip	:	44212-3660
Country	:	US
Telephone Number	:	330-225-3562
Fax Number	:

Provider Business Practice Location Address
First Line	:	7255 OLD OAK BLVD STE C405
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3331
Country	:	US
Telephone Number	:	440-816-5380
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/08/2007

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