Healthcare Provider Details

I. General information

NPI: 1417892969
Provider Name (Legal Business Name): LIAM DANIEL NUTTER AT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 E MAPLE ST
CANTON OH
44720-3336
US

IV. Provider business mailing address

3357 CAPRICIO ST NE
CANTON OH
44721-2702
US

V. Phone/Fax

Practice location:
  • Phone: 740-644-0044
  • Fax:
Mailing address:
  • Phone: 740-644-0044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT005998
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: