Provider Demographics
NPI:1619249943
Name:LITTLE, MICHAEL (ATC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LITTLE
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 1:4590 DONCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-2000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2900 HANNAH BOULEVARD
Practice Address - Street 2:SPORTS MEDICINE SUITE B102
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5374
Practice Address - Country:US
Practice Address - Phone:517-881-9359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010007982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer