Healthcare Provider Details

I. General information

NPI: 1780951541
Provider Name (Legal Business Name): DEBORAH JANE SPRINGER M.A,, AT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 ROBINSON RD SE 116 STURRUS
GRAND RAPIDS MI
49506-1741
US

IV. Provider business mailing address

116 STURRUS, 1607 ROBINSON RD. SE AQUINAS COLLEGE
GRAND RAPIDS MI
49506-1799
US

V. Phone/Fax

Practice location:
  • Phone: 616-632-2897
  • Fax: 616-732-4548
Mailing address:
  • Phone: 616-632-2897
  • Fax: 616-732-4548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2601000521
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: