Active NPI
Staci Lynn Bohannon, ATC
- Athletic Trainer
- Streetsboro, OH
National Provider Identifier
1225542129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT.004892
- Practice address
- 8585 Oh-14
Streetsboro, OH 44241 - Phone
- (440) 212-1383
- NPI assigned
- Nov 30, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT.004892 | OH | Primary |
Addresses
Primary practice location
8585 Oh-14
Streetsboro, OH 44241
Mailing address
638 Tampico CT
Berea, OH 44017-2636
Phone (440) 212-1383
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT.004892 | OH | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512000000000",
"number": "1225542129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "638 TAMPICO CT",
"city": "BEREA",
"state": "OH",
"postal_code": "440172636",
"telephone_number": "440-212-1383"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8585 OH-14",
"city": "STREETSBORO",
"state": "OH",
"postal_code": "44241",
"telephone_number": "440-212-1383"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOHANNON",
"first_name": "STACI",
"middle_name": "LYNN",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-11-30",
"last_updated": "2017-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OH",
"license": "AT.004892",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Streetsboro, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.