Healthcare Provider Details

I. General information

NPI: 1851410153
Provider Name (Legal Business Name): JOELLE M BEAUDOIN ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

06510 M-66 N
CHARLEVOIX MI
49720
US

IV. Provider business mailing address

6673 E HARBOR DR
ELK RAPIDS MI
49629-9533
US

V. Phone/Fax

Practice location:
  • Phone: 231-547-0380
  • Fax: 231-547-0395
Mailing address:
  • Phone: 231-264-0487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: