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NPI Code Detail

MEDICARE: MEG A SHARP ATC/L, CSCS

MEDICARE: MEG A SHARP ATC/L, CSCS
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
12255A2300XAthletic TrainerL2070507MI

General Provider Information

NPI Number : 1750667937
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEG A SHARP ATC/L, CSCS
Provider Business Mailing Address
First Line : 110 S MADISON ST
Second Line :
City : ADRIAN
State : MI
Zip : 49221-2518
Country : US
Telephone Number : 517-265-5161
Fax Number : 517-264-3869
Provider Business Practice Location Address
First Line : 110 S MADISON ST
Second Line :
City : ADRIAN
State : MI
Zip : 49221-2518
Country : US
Telephone Number : 517-265-5161
Fax Number : 517-264-3869
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2011
Last Update Date : 11/01/2011

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Directions to “ MEG A SHARP ATC/L, CSCS” Practice Location

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