Individual
MARIANA CREVISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
20 CEDAR ST, SCOTTSVILLE, NY 14546-1153
(585) 794-1805
Mailing address
20 CEDAR ST, SCOTTSVILLE, NY 14546-1153
(585) 794-1805
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
003594
NY
2255A2300X
Athletic Trainer
2000030410
NY
390200000X
Student in an Organized Health Care Education/Training Program
2255A2300X
NY
Other
Enumeration date
03/16/2017
Last updated
12/14/2017
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