Healthcare Provider Details

I. General information

NPI: 1053286401
Provider Name (Legal Business Name): PAIGE HUPPERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 10/24/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 MAPLE ST
FORT ATKINSON WI
53538-2522
US

IV. Provider business mailing address

1006 MAPLE ST
FORT ATKINSON WI
53538-2522
US

V. Phone/Fax

Practice location:
  • Phone: 920-728-2085
  • Fax:
Mailing address:
  • Phone: 920-728-2085
  • 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: