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NPI Code Detail

MEDICARE: SAMANTHA MALETTE ATC

MEDICARE:   SAMANTHA  MALETTE  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 Trainer2000022426

General Provider Information

NPI Number : 1669054383
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA MALETTE ATC
Provider Business Mailing Address
First Line : 1269 BARCLAY CIR SE
Second Line :
City : MARIETTA
State : GA
Zip : 30060-2903
Country : US
Telephone Number : 860-803-4914
Fax Number :
Provider Business Practice Location Address
First Line : 1269 BARCLAY CIR SE
Second Line :
City : MARIETTA
State : GA
Zip : 30060-2903
Country : US
Telephone Number : 860-803-4914
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2021
Last Update Date : 04/22/2021

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Directions to “ SAMANTHA MALETTE ATC” Practice Location

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