MEDICARE: NAOMI S CHANG 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	001558-1	NY

General Provider Information

NPI Number	:	1740545680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI S CHANG ATC

Provider Business Mailing Address
First Line	:	318 KIRKWOOD DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-4983
Country	:	US
Telephone Number	:	910-237-9867
Fax Number	:

Provider Business Practice Location Address
First Line	:	C-8247 ARDENNES ST
Second Line	:
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-5585
Country	:	US
Telephone Number	:	910-728-9810
Fax Number	:

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

Provider Enumeration Date	:	07/06/2012
Last Update Date	:	08/11/2022

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