Healthcare Provider Details

I. General information

NPI: 1609556000
Provider Name (Legal Business Name): MITCHELL GUY SEEWER MAT, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 06/10/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 W SOUTH ST
SAINT MARYS OH
45885-2221
US

IV. Provider business mailing address

430 W SOUTH ST
SAINT MARYS OH
45885-2221
US

V. Phone/Fax

Practice location:
  • Phone: 419-905-6534
  • Fax:
Mailing address:
  • Phone: 419-905-6534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT006968
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: