Healthcare Provider Details

I. General information

NPI: 1952701096
Provider Name (Legal Business Name): STEPHANIE MICHEL MS, ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 11/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OGLETOWN STANTON RD STE 225
NEWARK DE
19713-1387
US

IV. Provider business mailing address

214 MACDADE BLVD
MILMONT PARK PA
19033-3018
US

V. Phone/Fax

Practice location:
  • Phone: 302-731-2888
  • Fax:
Mailing address:
  • Phone: 610-772-5272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: