=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295883056
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEENAN KELLY ROBINSON ATC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 S STATE ST
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48109-2202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-647-1921
-----------------------------------------------------
Fax | 734-936-5182
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2005 HURON PKWY APARTMENT 1
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48104-4159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-408-3398
-----------------------------------------------------
Fax | 734-936-5182
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------