=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851410153
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOELLE M BEAUDOIN ATC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 06510 M-66 N
-----------------------------------------------------
City | CHARLEVOIX
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-547-0380
-----------------------------------------------------
Fax | 231-547-0395
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6673 E HARBOR DR
-----------------------------------------------------
City | ELK RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49629-9533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-264-0487
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------