Provider Demographics
NPI:1336604834
Name:MCCRARY, AUBURN REILLY
Entity type:Individual
Prefix:
First Name:AUBURN
Middle Name:REILLY
Last Name:MCCRARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:866 COUNTY ROAD 462
Mailing Address - Street 2:
Mailing Address - City:PISGAH
Mailing Address - State:AL
Mailing Address - Zip Code:35765-6932
Mailing Address - Country:US
Mailing Address - Phone:256-609-5309
Mailing Address - Fax:
Practice Address - Street 1:866 COUNTY ROAD 462
Practice Address - Street 2:
Practice Address - City:PISGAH
Practice Address - State:AL
Practice Address - Zip Code:35765-6932
Practice Address - Country:US
Practice Address - Phone:256-609-5309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer