Healthcare Provider Details

I. General information

NPI: 1699217844
Provider Name (Legal Business Name): MAKAYLA RENEE BUEHLER ATS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

02645 GLYNWOOD RD
SAINT MARYS OH
45885-9209
US

IV. Provider business mailing address

02645 GLYNWOOD RD
SAINT MARYS OH
45885-9209
US

V. Phone/Fax

Practice location:
  • Phone: 419-953-4034
  • Fax:
Mailing address:
  • Phone: 419-953-4034
  • 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: