Healthcare Provider Details

I. General information

NPI: 1316358351
Provider Name (Legal Business Name): CALLAN SAUNDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

V582 COUNTY ROAD 6
LIBERTY CENTER OH
43532
US

IV. Provider business mailing address

V582 COUNTY ROAD 6
LIBERTY CENTER OH
43532-9729
US

V. Phone/Fax

Practice location:
  • Phone: 419-966-4520
  • Fax:
Mailing address:
  • Phone: 419-966-4520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: