Healthcare Provider Details

I. General information

NPI: 1073575254
Provider Name (Legal Business Name): MICHELLE M BRAMLAGE ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 EASTERN BYP
RICHMOND KY
40475-2328
US

IV. Provider business mailing address

345 SPRINGHURST DR
BEREA KY
40403-8741
US

V. Phone/Fax

Practice location:
  • Phone: 859-623-4567
  • Fax: 859-623-7865
Mailing address:
  • Phone: 859-986-3418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT436
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: