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General NPI Number Information
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NPI Number | 1750419081
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Entity Type | Individual
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Provider Name | ERICA THOMPSON BAUMGARTNER ATC
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Gender | Female
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13B DOG LN
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City | STORRS MANSFIELD
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State | CT
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Zip | 06268-2206
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Country | US
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Telephone | 860-429-0899
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Fax | 860-429-0898
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Provider Business Mailing Address
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Address Line | 527 WEST THAMES STREET UNIT 56
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City | NORWICH
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State | CT
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Zip | 06360
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Country | US
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Telephone | 571-225-1411
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Fax | 860-429-0898
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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 | 000144
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License Number State | CT
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