Marisa Lynn Bogdonoff
Individual provider Active NPI Athletic Trainer · Storrs, CT
NPI 1700536265 · NPPES record last updated Mar 28, 2022
Key facts
- NPI
- 1700536265
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 7 Club House Cir Apt B
Storrs, CT 06268-1637 - Phone
- (973) 876-3260
- NPI assigned
- Mar 28, 2022
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Yes |
Addresses
Primary practice location
7 Club House Cir Apt B
Storrs, CT 06268-1637
Mailing address
7 Club House Cir Apt B
Storrs, CT 06268-1637
Phone (973) 876-3260
Other providers in Storrs, CT
- Eric Beck
- Avery Bernier
- Krista A Billard
- Ed Blair
- Catherine A Bochain
- Colleen Bonadies
- Lauren Nicole Brinsko
- Bailey Brochu
- Savaya Tioni Brockington
- Anne Butler
All providers in Storrs, CT · Athletic Trainer in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.