Provider Demographics
NPI:1518474733
Name:NEUBECKER, AIMEE MARIE (MS, AT, ATC)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:MARIE
Last Name:NEUBECKER
Suffix:
Gender:F
Credentials:MS, AT, ATC
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:MARIE
Other - Last Name:FRASIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6443 MISTY CT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1797
Mailing Address - Country:US
Mailing Address - Phone:616-889-9548
Mailing Address - Fax:
Practice Address - Street 1:4925 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2964
Practice Address - Country:US
Practice Address - Phone:616-889-9548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010008342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer