MEDICARE: MS. AMY C MARION LAT, 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-2108	NC
2	2255A2300X	Athletic Trainer	2108	NC

General Provider Information

NPI Number	:	1508284225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY C MARION LAT, ATC

Provider Business Mailing Address
First Line	:	7303 STRATH LN
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27518-6973
Country	:	US
Telephone Number	:	843-729-8266
Fax Number	:

Provider Business Practice Location Address
First Line	:	15033 BALLANCROFT PKWY STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-4959
Country	:	US
Telephone Number	:	704-316-2920
Fax Number	:	704-316-2921

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

Provider Enumeration Date	:	03/31/2014
Last Update Date	:	12/18/2020

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