Provider Demographics
NPI:1437364270
Name:WELLER, MICHAEL SEAN (ATC,LAT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SEAN
Last Name:WELLER
Suffix:
Gender:M
Credentials:ATC,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 WALRAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177
Mailing Address - Country:US
Mailing Address - Phone:937-383-7051
Mailing Address - Fax:
Practice Address - Street 1:1870 QUAKER WAY
Practice Address - Street 2:WILMINGTON COLLEGE
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177
Practice Address - Country:US
Practice Address - Phone:937-382-6661
Practice Address - Fax:937-383-8527
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0011642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer