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General NPI Number Information
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NPI Number | 1346648441
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Entity Type | Individual
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Provider Name | ASHLEY PUTNAM ATC
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Gender | Female
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Dates
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Enumeration Date | 12/05/2014
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Last Update Date | 07/20/2016
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Provider Practice Location Address
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Address Line | 6525 2ND AVE
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City | DETROIT
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State | MI
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Zip | 48202-3006
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Country | US
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Telephone | 313-970-8417
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Fax |
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Provider Business Mailing Address
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Address Line | 116 ELMWOOD ST
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City | DEARBORN
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State | MI
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Zip | 48124-1424
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Country | US
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Telephone | 814-450-3340
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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 | 004572
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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 | 2601001360
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License Number State | MI
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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 | 75
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License Number State | HI
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