Provider Demographics
NPI:1093046583
Name:GUY, VICKI J (ATC)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:J
Last Name:GUY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:J
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:791 W GENESEE STREET RD
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-9377
Mailing Address - Country:US
Mailing Address - Phone:314-685-7544
Mailing Address - Fax:315-685-7549
Practice Address - Street 1:791 W GENESEE STREET RD
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-9377
Practice Address - Country:US
Practice Address - Phone:314-685-7544
Practice Address - Fax:315-685-7549
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY67 0010222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer