MEDICARE: ALLYSON CARLY BROWN 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

General Provider Information

NPI Number	:	1669939443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYSON CARLY BROWN ATC

Provider Business Mailing Address
First Line	:	625 N 144TH AVE STE 102
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-1935
Country	:	US
Telephone Number	:	402-934-8688
Fax Number	:	402-934-8689

Provider Business Practice Location Address
First Line	:	625 N 144TH AVE STE 102
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-1935
Country	:	US
Telephone Number	:	402-934-8688
Fax Number	:	402-934-8689

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

Provider Enumeration Date	:	02/27/2019
Last Update Date	:	02/27/2019

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Directions to “ ALLYSON CARLY BROWN ATC” Practice Location

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