Healthcare Provider Details

I. General information

NPI: 1851385199
Provider Name (Legal Business Name): JOSEPH EDWARD LA MERE ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 GUNDERSEN DRIVE
ONALASKA WI
54650
US

IV. Provider business mailing address

902 REMINGTON DR
HOLMEN WI
54636-8705
US

V. Phone/Fax

Practice location:
  • Phone: 608-775-8611
  • Fax: 608-775-8614
Mailing address:
  • Phone: 608-526-2467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number179-39
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: