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General NPI Number Information
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NPI Number | 1336709534
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Entity Type | Organization
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Legal Business Name | CLARKSON UNIVERSITY
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Dates
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Enumeration Date | 06/19/2019
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Last Update Date | 06/19/2019
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Provider Practice Location Address
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Address Line | 8 CLARKSON AVE # 5830
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City | POTSDAM
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State | NY
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Zip | 13699-9001
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Country | US
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Telephone | 315-268-2123
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Fax | 315-268-6442
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Provider Business Mailing Address
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Address Line | 8 CLARKSON AVE # 5830
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City | POTSDAM
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State | NY
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Zip | 13699-9001
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Country | US
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Telephone | 315-268-2123
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Fax | 315-268-6442
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Authorized Official
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Title or Position | ASSISTANT ATHLETIC TRAINER
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Name | KATHRYN RYAN BISHOP
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Credential | LAT, ATC
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Telephone | 315-268-2123
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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 |
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License Number State |
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