MEDICARE: NATHAN JOHN MILLIKAN LAT, 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	004728	OH

General Provider Information

NPI Number	:	1316323421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN JOHN MILLIKAN LAT, ATC

Provider Business Mailing Address
First Line	:	616 CARRIAGE HILL DR
Second Line	:
City	:	ATHENS
State	:	OH
Zip	:	45701-3228
Country	:	US
Telephone Number	:	765-524-8173
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 OHIO UNIVERSITY
Second Line	:
City	:	ATHENS
State	:	OH
Zip	:	45701-2942
Country	:	US
Telephone Number	:	740-593-1000
Fax Number	:

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

Provider Enumeration Date	:	07/31/2015
Last Update Date	:	07/31/2015

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