Provider Demographics
NPI:1083070528
Name:DEWITT, AIMEE C (BS, LAT, ATC)
Entity Type:Individual
Prefix:MISS
First Name:AIMEE
Middle Name:C
Last Name:DEWITT
Suffix:
Gender:F
Credentials:BS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 ARBOR RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-1904
Mailing Address - Country:US
Mailing Address - Phone:321-704-5409
Mailing Address - Fax:
Practice Address - Street 1:121 N 20TH ST
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5449
Practice Address - Country:US
Practice Address - Phone:334-749-8303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer