MEDICARE: ALLISON ADALE EAVEY

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		IN
2	2255A2300X	Athletic Trainer	AT006996	OH
3	225100000X	Physical Therapist	PT021061

General Provider Information

NPI Number	:	1922586767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON ADALE EAVEY

Provider Business Mailing Address
First Line	:	900 N JOHN R WOODEN DR
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47907-2117
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2751 O'VARSITY WAY SUITE 265
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45221-2117
Country	:	US
Telephone Number	:	513-556-4352
Fax Number	:

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

Provider Enumeration Date	:	08/03/2018
Last Update Date	:	06/14/2024

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