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General NPI Number Information
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NPI Number | 1942837836
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Entity Type | Individual
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Provider Name | MICHELE CHRISTINE BLISS ATC, LAT, CES
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Gender | Female
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Dates
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Enumeration Date | 03/23/2020
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Last Update Date | 03/23/2020
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Provider Practice Location Address
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Address Line | 97 SPEAR ST
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City | BURLINGTON
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State | VT
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Zip | 05405-1701
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Country | US
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Telephone | 201-787-5630
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Fax |
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Provider Business Mailing Address
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Address Line | 79 WEAVER ST APT A
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City | WINOOSKI
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State | VT
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Zip | 05404-2073
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Country | US
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Telephone | 201-787-5630
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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 | 104.0123206
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License Number State | VT
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