Provider Demographics
NPI:1174012280
Name:KARCHER, COLLIN JACOB (AT, ATC)
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:JACOB
Last Name:KARCHER
Suffix:
Gender:M
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48491 SUGARBUSH RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-3325
Mailing Address - Country:US
Mailing Address - Phone:810-247-1011
Mailing Address - Fax:
Practice Address - Street 1:11 GROSSE POINTE BLVD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-3711
Practice Address - Country:US
Practice Address - Phone:313-432-3581
Practice Address - Fax:313-432-3544
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010018122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer