Individual
CHIQUITTA LEOLA NICOLE MCBRAYER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT ATC
Contact information
Practice address
211 HOSPITAL RD, RED BAY, AL 35582-3858
(256) 460-7111
Mailing address
9602 HOLT SPRINGER RD, ATHENS, AL 35611-8162
(256) 460-7111
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1524
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1524
STATE ATHLETIC TRAINER LICENSE
AL
01
—
2000014549
BOARD OF CERTIFICATION NUMBER
AL
01
—
8123035
DRIVERS LICENSE
AL
Enumeration date
09/25/2016
Last updated
09/25/2016
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