MEDICARE: MATTHEW CHARLES WOOD MS, AT

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	AT. 004088	OH

General Provider Information

NPI Number	:	1427407584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW CHARLES WOOD MS, AT

Provider Business Mailing Address
First Line	:	270 S LOCUST ST
Second Line	:
City	:	OXFORD
State	:	OH
Zip	:	45056-1718
Country	:	US
Telephone Number	:	513-378-3910
Fax Number	:

Provider Business Practice Location Address
First Line	:	946 STONE RIDGE LN
Second Line	:
City	:	LEBANON
State	:	OH
Zip	:	45036-8530
Country	:	US
Telephone Number	:	513-378-3910
Fax Number	:

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

Provider Enumeration Date	:	06/09/2016
Last Update Date	:	06/09/2016

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