MEDICARE: CALLY MARIE MACKRELL 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	LAT-2706	NC
2	2255A2300X	Athletic Trainer	A0001240	MD

General Provider Information

NPI Number	:	1497121057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALLY MARIE MACKRELL ATC

Provider Business Mailing Address
First Line	:	8512 HILL ST
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4615
Country	:	US
Telephone Number	:	443-878-9279
Fax Number	:

Provider Business Practice Location Address
First Line	:	8512 HILL ST
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4615
Country	:	US
Telephone Number	:	443-878-9279
Fax Number	:

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

Provider Enumeration Date	:	08/18/2015
Last Update Date	:	11/09/2021

Similar Medicare Providers

1174679559 — STACEY FUSELIER PIERCE LPC, LMFT, NCC
Practice Location Address:

401 HAMILTON RD STE 114
BOSSIER CITY, LA
71111-4615

Practice Phone: 318-286-7454
Practice Fax: 318-286-7454

1487772489 — MS. CATERINA DI PALMA DOM
Practice Location Address:

1207 N VIRGINIA ST
SILVER CITY, NM
88061-4615

Practice Phone: 575-956-6813
Practice Fax: 575-956-6813

1841481645 — MISS CHRISTINA M. GERTEIS LPC, LAC, MAC
Practice Location Address:

401 HAMILTON RD STE 114
BOSSIER CITY, LA
71111-4615

Practice Phone: 970-829-0982
Practice Fax:

1861668105 — DR. FREDERICK L. DATZ M.D.
Practice Location Address:

4615 FORTUNA WAY
SALT LAKE CITY, UT
84124-4764

Practice Phone: 801-272-0634
Practice Fax:

1972762664 — DR. ANITA KANTILAL PATEL M.D.
Practice Location Address:

4615 CENTER BLVD , APT 310
LONG ISLAND CITY, NY
11109-5738

Practice Phone: 402-578-6819
Practice Fax:

1972865681 — MRS. TATYANA VLADOVA MS SP. ED.
Practice Location Address:

4615 CENTER BLVD , #907
LONG ISLAND CITY, NY
11109-5738

Practice Phone: 646-824-6716
Practice Fax:

Directions to “ CALLY MARIE MACKRELL ATC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.