MEDICARE: MISS ALYSSA MARIE OGILVIE 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	AT006799	OH

General Provider Information

NPI Number	:	1902418320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ALYSSA MARIE OGILVIE ATC

Provider Business Mailing Address
First Line	:	2815 SOMIA DR
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44134-3929
Country	:	US
Telephone Number	:	440-334-4926
Fax Number	:

Provider Business Practice Location Address
First Line	:	1911 W 30TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-3495
Country	:	US
Telephone Number	:	216-651-0222
Fax Number	:

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

Provider Enumeration Date	:	08/18/2020
Last Update Date	:	01/07/2024

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