Provider Demographics
NPI:1902457591
Name:TOMLINSON, MAGGIE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:TOMLINSON
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 COLLEGE AVE # MSC1667
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2600
Mailing Address - Country:US
Mailing Address - Phone:304-473-8000
Mailing Address - Fax:
Practice Address - Street 1:59 COLLEGE AVE # MSC1667
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2600
Practice Address - Country:US
Practice Address - Phone:304-473-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL52412255A2300X
WVAT0016352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer