MEDICARE: EMILY KAY GALLOWAY 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	SC509908	SC

General Provider Information

NPI Number	:	1972162659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY KAY GALLOWAY ATC

Provider Business Mailing Address
First Line	:	2732 LORRIE DR
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45434-6443
Country	:	US
Telephone Number	:	937-479-7832
Fax Number	:

Provider Business Practice Location Address
First Line	:	2732 LORRIE DR
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45434-6443
Country	:	US
Telephone Number	:	937-479-7832
Fax Number	:

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

Provider Enumeration Date	:	06/06/2019
Last Update Date	:	06/06/2019

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