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General NPI Number Information
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NPI Number | 1750149878
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Entity Type | Individual
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Provider Name | CLAIRE STANNERS MAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 03/12/2024
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Last Update Date | 03/12/2024
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Provider Practice Location Address
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Address Line | 2001 ALFORD PARK DR
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City | KENOSHA
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State | WI
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Zip | 53140-1927
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Country | US
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Telephone | 173-478-7252
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Fax |
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Provider Business Mailing Address
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Address Line | 999 WOOD RD APT 203
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City | KENOSHA
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State | WI
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Zip | 53144-1154
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Country | US
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Telephone | 734-787-2523
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 3145-39
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License Number State | WI
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