Healthcare Provider Details

I. General information

NPI: 1932506573
Provider Name (Legal Business Name): CORA OHNSTAD MS, AT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W FAIR AVE SUITE 190
MARQUETTE MI
49855-2675
US

IV. Provider business mailing address

1414 W FAIR AVE SUITE 190
MARQUETTE MI
49855-2675
US

V. Phone/Fax

Practice location:
  • Phone: 906-280-1884
  • Fax: 906-225-4605
Mailing address:
  • Phone: 906-280-1884
  • Fax: 906-225-4605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2601000778
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: