Healthcare Provider Details

I. General information

NPI: 1528088424
Provider Name (Legal Business Name): JOHN ADAM OSTROWSKI MS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COLLEGE ST BOX 7A
WORCESTER MA
01610-2322
US

IV. Provider business mailing address

610 APPLEBRIAR LN
MARLBOROUGH MA
01752-4623
US

V. Phone/Fax

Practice location:
  • Phone: 508-793-2627
  • Fax: 508-793-3974
Mailing address:
  • Phone: 508-793-2627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1719
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: