Provider Demographics
NPI:1265841662
Name:BISBEE, LAINIE (ATC)
Entity Type:Individual
Prefix:
First Name:LAINIE
Middle Name:
Last Name:BISBEE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 W MCNICHOLS RD
Mailing Address - Street 2:CALIHAN HALL
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-3038
Mailing Address - Country:US
Mailing Address - Phone:313-993-1740
Mailing Address - Fax:313-993-1741
Practice Address - Street 1:4001 W MCNICHOLS RD
Practice Address - Street 2:CALIHAN HALL
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-3038
Practice Address - Country:US
Practice Address - Phone:313-993-1740
Practice Address - Fax:313-993-1741
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010007672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer