MEDICARE: MS. MELISSA HUEY ATC, LAT

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	36001067A	IN

General Provider Information

NPI Number	:	1861487928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA HUEY ATC, LAT

Provider Business Mailing Address
First Line	:	10830 ARCARO LN
Second Line	:
City	:	UNION
State	:	KY
Zip	:	41091-9201
Country	:	US
Telephone Number	:	859-746-3118
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 E BUSINESS WAY
Second Line	:	SUITE C
City	:	CINCINNATI
State	:	OH
Zip	:	45241-2374
Country	:	US
Telephone Number	:	513-389-3665
Fax Number	:

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	11/02/2007

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