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NPI Code Detail

MEDICARE: AMANDA DIXON

MEDICARE: AMANDA DIXON
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
1390200000XStudent in an Organized Health Care Education/Training Program
22255A2300XAthletic TrainerAT001832WV

General Provider Information

NPI Number : 1740827492
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA DIXON
Provider Business Mailing Address
First Line : 3878 MOUNT PLEASANT ST NW APT E
Second Line :
City : NORTH CANTON
State : OH
Zip : 44720-4778
Country : US
Telephone Number : 330-714-8937
Fax Number :
Provider Business Practice Location Address
First Line : 3878 MOUNT PLEASANT ST NW APT E
Second Line :
City : NORTH CANTON
State : OH
Zip : 44720-4778
Country : US
Telephone Number : 330-714-8937
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2019
Last Update Date : 07/06/2022

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Directions to “ AMANDA DIXON ” Practice Location

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