MEDICARE: DREW E STYMA 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	2601001146	MI

General Provider Information

NPI Number	:	1417377235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DREW E STYMA ATC

Provider Business Mailing Address
First Line	:	1333 SPRING ST
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8720
Country	:	US
Telephone Number	:	231-487-4638
Fax Number	:	231-487-4615

Provider Business Practice Location Address
First Line	:	1333 SPRING ST
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8720
Country	:	US
Telephone Number	:	231-487-4638
Fax Number	:	231-487-4615

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

Provider Enumeration Date	:	04/19/2014
Last Update Date	:	04/19/2014

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Directions to “ DREW E STYMA ATC” Practice Location

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