Healthcare Provider Details

I. General information

NPI: 1578840609
Provider Name (Legal Business Name): MICHELLE RENEE COLVIN MA, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE RENEE TRUMBULL MA, ATC

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7595 COUNTY ROAD 236
FINDLAY OH
45840-8738
US

IV. Provider business mailing address

7595 COUNTY ROAD 236
FINDLAY OH
45840-8738
US

V. Phone/Fax

Practice location:
  • Phone: 419-427-1984
  • Fax: 419-427-2326
Mailing address:
  • Phone: 419-427-1984
  • Fax: 419-427-2326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT.003597
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: