Healthcare Provider Details

I. General information

NPI: 1184646770
Provider Name (Legal Business Name): WILLIAM LAMAR WARD ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 GUNDERSON RD
ONALASKA WI
54650-8447
US

IV. Provider business mailing address

3111 GUNDERSON DRIVE
ONALASKA WI
54650
US

V. Phone/Fax

Practice location:
  • Phone: 608-775-8600
  • Fax: 608-775-8614
Mailing address:
  • Phone: 608-775-8600
  • Fax: 608-775-8614

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: