MEDICARE: REBEKKAH DANIELLE GASTON 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	AT005801	OH

General Provider Information

NPI Number	:	1376827063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBEKKAH DANIELLE GASTON ATC

Provider Business Mailing Address
First Line	:	206 DARST RD APT 3A
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45440-3443
Country	:	US
Telephone Number	:	513-315-4505
Fax Number	:

Provider Business Practice Location Address
First Line	:	1231 W KEMPER RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-1617
Country	:	US
Telephone Number	:	513-315-4505
Fax Number	:

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

Provider Enumeration Date	:	09/29/2011
Last Update Date	:	06/10/2020

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