Provider Demographics
NPI:1518355114
Name:SHOUGH, BRITTANY LYNN (AT, ATC)
Entity Type:Individual
Prefix:MISS
First Name:BRITTANY
Middle Name:LYNN
Last Name:SHOUGH
Suffix:
Gender:F
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1193 CORNISH DR
Mailing Address - Street 2:
Mailing Address - City:DE GRAFF
Mailing Address - State:OH
Mailing Address - Zip Code:43318-9617
Mailing Address - Country:US
Mailing Address - Phone:937-622-0889
Mailing Address - Fax:
Practice Address - Street 1:1193 CORNISH DR
Practice Address - Street 2:
Practice Address - City:DE GRAFF
Practice Address - State:OH
Practice Address - Zip Code:43318-9617
Practice Address - Country:US
Practice Address - Phone:937-622-0889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OHAT.0049222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program