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General NPI Number Information
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NPI Number | 1710944657
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Entity Type | Individual
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Provider Name | MICHAEL J. WILLETS A.T.C.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 700 S LIMESTONE ST
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City | SPRINGFIELD
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State | OH
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Zip | 45505-1941
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Country | US
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Telephone | 937-328-2027
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Fax | 937-328-6866
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Provider Business Mailing Address
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Address Line | 2734 COUNTRY SQUIRE DR
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City | NEW CARLISLE
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State | OH
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Zip | 45344-9566
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Country | US
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Telephone | 937-845-1411
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Fax | 937-845-9784
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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 179
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License Number State | OH
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