Provider Demographics
NPI:1417129503
Name:OUELLETTE, MICHAEL TROY (ATC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TROY
Last Name:OUELLETTE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 HUDSON RD
Mailing Address - Street 2:UNI-HUMAN PERFORMANCE CENTER
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50614-0065
Mailing Address - Country:US
Mailing Address - Phone:319-415-7558
Mailing Address - Fax:319-273-2073
Practice Address - Street 1:2351 HUDSON RD
Practice Address - Street 2:UNI-HUMAN PERFORMANCE CENTER
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50614-0065
Practice Address - Country:US
Practice Address - Phone:319-415-7558
Practice Address - Fax:319-273-2073
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0006422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer