MEDICARE: CELINA FELTON AT, 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	AT005066	OH

General Provider Information

NPI Number	:	1982114575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELINA FELTON AT, ATC

Provider Business Mailing Address
First Line	:	2600 CLEVELAND AVE NW
Second Line	:	ATTN: ATHLETICS
City	:	CANTON
State	:	OH
Zip	:	44709-3308
Country	:	US
Telephone Number	:	440-409-9691
Fax Number	:	330-471-8298

Provider Business Practice Location Address
First Line	:	8563 EDGERTON RD
Second Line	:
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-5645
Country	:	US
Telephone Number	:	440-409-9691
Fax Number	:

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

Provider Enumeration Date	:	10/09/2017
Last Update Date	:	10/09/2017

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