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NPI Code Detail

MEDICARE: AREN DEHN MOORMAN ATC

MEDICARE: AREN DEHN MOORMAN 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
12255A2300XAthletic TrainerAT001406WV

General Provider Information

NPI Number : 1588114995
Entity Type Code : Individual
Provider Name (Legal Business Name) : AREN DEHN MOORMAN ATC
Provider Business Mailing Address
First Line : 1 CAMPUS VIEW DR
Second Line :
City : VIENNA
State : WV
Zip : 26105-8000
Country : US
Telephone Number : 401-649-9952
Fax Number :
Provider Business Practice Location Address
First Line : 1 CAMPUS VIEW DR
Second Line :
City : VIENNA
State : WV
Zip : 26105-8000
Country : US
Telephone Number : 401-649-9952
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2016
Last Update Date : 10/10/2016

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Directions to “ AREN DEHN MOORMAN ATC” Practice Location

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