MEDICARE: DANIELLE COVIELLO 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	2000027354	NC

General Provider Information

NPI Number	:	1538656780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE COVIELLO LAT, ATC

Provider Business Mailing Address
First Line	:	108 BROWNLEA DR APT 4
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27858-1643
Country	:	US
Telephone Number	:	203-826-6807
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 W 5TH ST
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-1603
Country	:	US
Telephone Number	:	203-826-6807
Fax Number	:

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

Provider Enumeration Date	:	04/13/2018
Last Update Date	:	04/13/2018

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