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NPI Code Detail

MEDICARE: LEAMAE KING MS, A.T.C.

MEDICARE: LEAMAE KING MS, A.T.C.
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 Trainer

General Provider Information

NPI Number : 1871336321
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAMAE KING MS, A.T.C.
Provider Business Mailing Address
First Line : 4208 STRATFORD CT
Second Line :
City : HOBART
State : WI
Zip : 54155-9174
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1970 S RIDGE RD
Second Line :
City : GREEN BAY
State : WI
Zip : 54304-4125
Country : US
Telephone Number : 920-430-4888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2024
Last Update Date : 06/03/2026

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