Provider Demographics
NPI:1114105327
Name:WILLIAM WOODS UNIVERSITY ATHLETIC TRAINING SERVICES
Entity Type:Organization
Organization Name:WILLIAM WOODS UNIVERSITY ATHLETIC TRAINING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD ATHLETIC TRAINER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAINES
Authorized Official - Suffix:
Authorized Official - Credentials:ATCL
Authorized Official - Phone:573-592-4388
Mailing Address - Street 1:ONE UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-2388
Mailing Address - Country:US
Mailing Address - Phone:573-592-4388
Mailing Address - Fax:573-592-4386
Practice Address - Street 1:ONE UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-2388
Practice Address - Country:US
Practice Address - Phone:573-592-4388
Practice Address - Fax:573-592-4386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020058412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty