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NPI Code Detail

MEDICARE: MCKENZIE SARA OWENS ATC, EMT

MEDICARE: MCKENZIE SARA OWENS ATC, EMT
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 Trainer1352CT

General Provider Information

NPI Number : 1326524471
Entity Type Code : Individual
Provider Name (Legal Business Name) : MCKENZIE SARA OWENS ATC, EMT
Provider Business Mailing Address
First Line : 19 HAMPTON RD
Second Line :
City : EAST HAVEN
State : CT
Zip : 06512
Country : US
Telephone Number : 203-824-9044
Fax Number :
Provider Business Practice Location Address
First Line : 275 MOUNT CARMEL AVE
Second Line :
City : HAMDEN
State : CT
Zip : 06518-1908
Country : US
Telephone Number : 203-824-9044
Fax Number : 203-582-3207
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2018
Last Update Date : 05/28/2024

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