MEDICARE: MITCHELL ETHIER

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	:	1528995388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL ETHIER

Provider Business Mailing Address
First Line	:	1723 HIGHLANDVIEW DR
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-4665
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1723 HIGHLANDVIEW DR
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-4665
Country	:	US
Telephone Number	:	262-308-7798
Fax Number	:

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

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/06/2026

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Directions to “ MITCHELL ETHIER ” Practice Location

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