Healthcare Provider Details

I. General information

NPI: 1154089779
Provider Name (Legal Business Name): LAUREN ELIZABETH LINN ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 JENSON DR APT G
SPRINGFIELD OH
45503-6712
US

IV. Provider business mailing address

3910 JENSON DR APT G
SPRINGFIELD OH
45503-6712
US

V. Phone/Fax

Practice location:
  • Phone: 937-244-7160
  • Fax:
Mailing address:
  • Phone: 937-244-7160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT006791
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: