Individual
HOGAN NICKLAUS MARSHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AT
Contact information
Practice address
7118 MOUNT ROYAL AVE, WESTERVILLE, OH 43082
(614) 797-6800
Mailing address
214 SCARLET OAK DR, MONROE, OH 45050-2520
(513) 335-2656
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT005644
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000031812
BOARD OF CERTIFICATION
—
01
—
AT005644
OTPTAT LICENSURE BOARD
OH
Enumeration date
01/26/2018
Last updated
06/30/2018
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