Healthcare Provider Details

I. General information

NPI: 1982895207
Provider Name (Legal Business Name): STEPHANIE LEE ADAMS A.T.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8391 E. COMMERCE RD. SUITE 108
COMMERCE TOWNSHIP MI
48382
US

IV. Provider business mailing address

9640 COMMERCE RD SUITE 202
COMMERCE TOWNSHIP MI
48382-4166
US

V. Phone/Fax

Practice location:
  • Phone: 248-360-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: