MEDICARE: BETH HAUCK 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	1935	OH

General Provider Information

NPI Number	:	1437621935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH HAUCK AT

Provider Business Mailing Address
First Line	:	35475 KELLER DR
Second Line	:
City	:	AVON
State	:	OH
Zip	:	44011-1945
Country	:	US
Telephone Number	:	440-610-3133
Fax Number	:

Provider Business Practice Location Address
First Line	:	37545 DETROIT RD
Second Line	:
City	:	AVON
State	:	OH
Zip	:	44011-2133
Country	:	US
Telephone Number	:	440-610-3133
Fax Number	:

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

Provider Enumeration Date	:	12/20/2018
Last Update Date	:	12/20/2018

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Directions to “ BETH HAUCK AT” Practice Location

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