Provider Demographics
NPI:1609848142
Name:STANLEY, AUDREY C (MS, LAT, ATC)
Entity Type:Individual
Prefix:MISS
First Name:AUDREY
Middle Name:C
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 PRIDEMORE ST
Mailing Address - Street 2:APT 6
Mailing Address - City:CHURCH HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37642-3871
Mailing Address - Country:US
Mailing Address - Phone:614-571-2220
Mailing Address - Fax:
Practice Address - Street 1:1050 VOLUNTEER ST
Practice Address - Street 2:
Practice Address - City:CHURCH HILL
Practice Address - State:TN
Practice Address - Zip Code:37642-4435
Practice Address - Country:US
Practice Address - Phone:423-357-3641
Practice Address - Fax:423-357-6694
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000010672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer