MEDICARE: MR. DARRELL EDWARD REED 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	AT000327	OH

General Provider Information

NPI Number	:	1689655763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DARRELL EDWARD REED ATC

Provider Business Mailing Address
First Line	:	5794 NEARING CIRCLE DR
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-1937
Country	:	US
Telephone Number	:	440-257-3309
Fax Number	:	866-235-6923

Provider Business Practice Location Address
First Line	:	4480 RICHMOND RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-5777
Country	:	US
Telephone Number	:	216-595-2880
Fax Number	:	216-595-2879

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	07/08/2007

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