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General NPI Number Information
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NPI Number | 1437520806
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Entity Type | Individual
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Provider Name | MICHAELYN SEBOLD MA, ATC, CES, LMT
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Gender | Female
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 35259 23 MILE RD
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City | NEW BALTIMORE
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State | MI
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Zip | 48047-3651
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Country | US
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Telephone | 586-805-9383
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Fax |
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Provider Business Mailing Address
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Address Line | 35259 23 MILE RD
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City | NEW BALTIMORE
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State | MI
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Zip | 48047-3651
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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 | AT-2494
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 7501011408
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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 | 2601000909
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License Number State | MI
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