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NPI Code Detail

MEDICARE: MR. COREY MICHAEL HANNAH MS ATC/L

MEDICARE: MR. COREY MICHAEL HANNAH MS ATC/L
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 TrainerAT 2589OH

General Provider Information

NPI Number : 1811950199
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. COREY MICHAEL HANNAH MS ATC/L
Provider Business Mailing Address
First Line : 2565 EDGEWOOD AVE
Second Line :
City : ALLIANCE
State : OH
Zip : 44601-4613
Country : US
Telephone Number : 330-829-8715
Fax Number : 330-823-4896
Provider Business Practice Location Address
First Line : 1972 CLARK AVE
Second Line :
City : ALLIANCE
State : OH
Zip : 44601-3929
Country : US
Telephone Number : 330-829-8715
Fax Number : 330-823-4896
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2006
Last Update Date : 07/08/2007

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