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NPI Code Detail

MEDICARE: MRS. MELISSA LYN O'BRIEN A.T.C.

MEDICARE: MRS. MELISSA LYN O'BRIEN A.T.C.
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 TrainerRT002023APA
22255A2300XAthletic Trainer000318-1NY

General Provider Information

NPI Number : 1932174059
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MELISSA LYN O'BRIEN A.T.C.
Provider Business Mailing Address
First Line : PO BOX 34
Second Line :
City : CERES
State : NY
Zip : 14721-0034
Country : US
Telephone Number : 585-933-0058
Fax Number :
Provider Business Practice Location Address
First Line : 1001 E 2ND ST
Second Line :
City : COUDERSPORT
State : PA
Zip : 16915-8161
Country : US
Telephone Number : 814-887-5214
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2006
Last Update Date : 07/08/2007

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