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General NPI Number Information
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NPI Number | 1285206136
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Entity Type | Individual
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Provider Name | SAMANTHA NICOLE ALTAMIRANO ATC
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Gender | Female
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Dates
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Enumeration Date | 07/12/2021
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Last Update Date | 07/12/2021
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Provider Practice Location Address
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Address Line | 205 N EAST AVE
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City | JACKSON
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State | MI
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Zip | 49201-1753
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Country | US
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Telephone | 509-307-7422
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Fax |
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Provider Business Mailing Address
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Address Line | 1149 DESOTO AVE
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City | YPSILANTI
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State | MI
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Zip | 48198-6279
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Country | US
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Telephone |
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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 | AT005906
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 60865271
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2601002102
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License Number State | MI
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