MEDICARE: MRS. MARIA LINDAHL AT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1245365964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA LINDAHL AT, ATC

Provider Business Mailing Address
First Line	:	348 LONG RAPIDS PLZ
Second Line	:
City	:	ALPENA
State	:	MI
Zip	:	49707-1374
Country	:	US
Telephone Number	:	989-358-8086
Fax Number	:	989-354-2253

Provider Business Practice Location Address
First Line	:	348 LONG RAPIDS PLZ
Second Line	:
City	:	ALPENA
State	:	MI
Zip	:	49707-1374
Country	:	US
Telephone Number	:	989-358-8086
Fax Number	:	989-354-2253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	05/12/2015

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