Provider Demographics
NPI:1740691716
Name:HAVE TABLE WILL TRAVEL
Entity type:Organization
Organization Name:HAVE TABLE WILL TRAVEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD ATHLETIC TRAINER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:T
Authorized Official - Last Name:FLANAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:ATC
Authorized Official - Phone:216-659-7173
Mailing Address - Street 1:4792 W. STREETSBORO ROAD
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286
Mailing Address - Country:US
Mailing Address - Phone:216-659-7173
Mailing Address - Fax:
Practice Address - Street 1:4792 W. STREETSBORO ROAD
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44286
Practice Address - Country:US
Practice Address - Phone:216-659-7173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty