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NPI Code Detail

MEDICARE: MARCELINA MARIE GRODHAUS MS, ATC

MEDICARE: MARCELINA MARIE GRODHAUS MS, 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
12255A2300XAthletic TrainerAT 002223OH

General Provider Information

NPI Number : 1275687006
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARCELINA MARIE GRODHAUS MS, ATC
Provider Business Mailing Address
First Line : 76 W MAIN ST
Second Line :
City : SALINEVILLE
State : OH
Zip : 43945-1081
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1972 CLARK AVE
Second Line :
City : ALLIANCE
State : OH
Zip : 44601-3929
Country : US
Telephone Number : 330-823-4668
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2007
Last Update Date : 07/08/2007

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