Healthcare Provider Details

I. General information

NPI: 1811267248
Provider Name (Legal Business Name): CLAIRE G COATES MS, AT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CLAIRE E GRAVES

II. Dates (important events)

Enumeration Date: 01/02/2012
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S STATE ST
ANN ARBOR MI
48109
US

IV. Provider business mailing address

6664 BUCK XING
YPSILANTI MI
48197-6838
US

V. Phone/Fax

Practice location:
  • Phone: 734-763-4000
  • Fax:
Mailing address:
  • Phone: 941-524-0073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number2601001247
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL 2717
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: