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General NPI Number Information
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NPI Number | 1568811958
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Entity Type | Individual
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Provider Name | JANEEN ANN BEETLE LAT; ATC
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Gender | Female
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Dates
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Enumeration Date | 06/07/2016
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Last Update Date | 06/07/2016
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Provider Practice Location Address
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Address Line | 82 NEW PARK AVE
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City | NORTH FRANKLIN
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State | CT
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Zip | 06254-1807
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Country | US
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Telephone | 860-823-6221
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Fax |
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Provider Business Mailing Address
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Address Line | 12 SABRINAS CT
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City | NORWICH
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State | CT
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Zip | 06360-1678
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Country | US
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Telephone | 860-912-7802
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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 | 000263
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License Number State | CT
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