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NPI Code Detail

MEDICARE: MISS BRITTANY LYNN SHOUGH AT, ATC

MEDICARE:  MISS BRITTANY LYNN SHOUGH  AT, 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
1390200000XStudent in an Organized Health Care Education/Training Program
22255A2300XAthletic TrainerAT.004922OH

General Provider Information

NPI Number : 1518355114
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS BRITTANY LYNN SHOUGH AT, ATC
Provider Business Mailing Address
First Line : 1193 CORNISH DR
Second Line :
City : DE GRAFF
State : OH
Zip : 43318-9617
Country : US
Telephone Number : 937-622-0889
Fax Number :
Provider Business Practice Location Address
First Line : 1193 CORNISH DR
Second Line :
City : DE GRAFF
State : OH
Zip : 43318-9617
Country : US
Telephone Number : 937-622-0889
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2015
Last Update Date : 04/01/2016

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Directions to “ MISS BRITTANY LYNN SHOUGH AT, ATC” Practice Location

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