MEDICARE: MOLLY WOODS

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

General Provider Information

NPI Number	:	1891285441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY WOODS

Provider Business Mailing Address
First Line	:	500 LOUIE B NUNN DRIVE
Second Line	:
City	:	NEWPORT
State	:	KY
Zip	:	41099-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 LOUIE B NUNN DRIVE
Second Line	:
City	:	NEWPORT
State	:	KY
Zip	:	41099-0001
Country	:	US
Telephone Number	:	859-572-1487
Fax Number	:

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

Provider Enumeration Date	:	05/18/2018
Last Update Date	:	05/18/2018

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Directions to “ MOLLY WOODS ” Practice Location

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