Healthcare Provider Details

I. General information

NPI: 1134635303
Provider Name (Legal Business Name): CHELSEA LEANN RANJEL MHA, AT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS CHELSEA LEANN READ

II. Dates (important events)

Enumeration Date: 12/23/2017
Last Update Date: 12/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 OAK ST UNIT 11
BIG RAPIDS MI
49307-3108
US

IV. Provider business mailing address

23581 15 MILE RD
BIG RAPIDS MI
49307-9228
US

V. Phone/Fax

Practice location:
  • Phone: 231-305-3375
  • Fax: 231-305-3093
Mailing address:
  • Phone: 517-285-0634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2601000868
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: