Healthcare Provider Details

I. General information

NPI: 1730603432
Provider Name (Legal Business Name): MICHAEL ANTHONY LAMMERS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8568 ROAD F6
LEIPSIC OH
45856-9410
US

IV. Provider business mailing address

8568 ROAD F6
LEIPSIC OH
45856-9410
US

V. Phone/Fax

Practice location:
  • Phone: 419-969-9459
  • Fax: 419-943-2584
Mailing address:
  • Phone: 419-969-9459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT006170
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: