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General NPI Number Information
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NPI Number | 1205828613
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Entity Type | Individual
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Provider Name | JAMES TEWELES SHLIMOVITZ LAT
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Gender | Male
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 09/24/2015
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Provider Practice Location Address
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Address Line | 707 14TH ST
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City | BARABOO
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State | WI
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Zip | 53913-1539
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Country | US
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Telephone | 608-356-1478
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Fax |
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Provider Business Mailing Address
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Address Line | 515 OAKRIDGE DR
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City | PORTAGE
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State | WI
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Zip | 53901-1219
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Country | US
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Telephone | 608-742-8470
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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 | 43-039
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License Number State | WI
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