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General NPI Number Information
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NPI Number | 1861960726
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Entity Type | Individual
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Provider Name | WILLIAM STEPHENS ATC
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Gender | Male
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Dates
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Enumeration Date | 11/08/2018
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 11050 MOUNT BELVEDERE BLVD
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City | FORT DRUM
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State | NY
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Zip | 13602-5438
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Country | US
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Telephone | 315-772-2778
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Fax |
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Provider Business Mailing Address
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Address Line | 1844 SOMERFORD DR
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City | GALENA
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State | OH
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Zip | 43021-8132
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Country | US
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Telephone | 614-949-2647
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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 |
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License Number State | OH
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