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General NPI Number Information
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NPI Number | 1487250718
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Entity Type | Individual
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Provider Name | CHRIS ATWATER
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Gender | Male
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Dates
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Enumeration Date | 12/10/2020
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 5047 WORCHESTER DR
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City | DAYTON
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State | OH
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Zip | 45431-1137
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Country | US
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Telephone | 614-749-8748
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Fax |
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Provider Business Mailing Address
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Address Line | 5047 WORCHESTER DR
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City | DAYTON
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State | OH
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Zip | 45431-1137
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Country | US
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Telephone | 614-749-8748
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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 | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number | GCW8541
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License Number State | OH
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