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General NPI Number Information
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NPI Number | 1063615680
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Entity Type | Individual
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Provider Name | LISA M MOTZ ATC
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Gender | Female
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Dates
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Enumeration Date | 06/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1200 WILLARD ST
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City | WASHINGTON COURT HOUSE
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State | OH
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Zip | 43160-2376
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Country | US
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Telephone | 740-335-0820
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Fax |
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Provider Business Mailing Address
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Address Line | 523 W ELM ST
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City | WASHINGTON COURT HOUSE
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State | OH
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Zip | 43160-1845
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Country | US
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Telephone | 740-636-0714
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT00634
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License Number State | OH
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