Healthcare Provider Details

I. General information

NPI: 1487074340
Provider Name (Legal Business Name): MARC EILERS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 04/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

484 BALL DR
HANOVER IN
47243-9669
US

IV. Provider business mailing address

328 POPLAR ST
MADISON IN
47250-3740
US

V. Phone/Fax

Practice location:
  • Phone: 812-866-7379
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255R0406X
TaxonomyBlind Rehabilitation Specialist/Technologist
License Number2000001994
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: